The Florida Senate. Interim Report September 2011 REVIEW ELIGIBILITY OF DENTIST LICENSURE IN FLORIDA AND OTHER JURISDICTIONS

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1 Cmmittee n Health Regulatin The Flrida Senate Interim Reprt September 2011 REVIEW ELIGIBILITY OF DENTIST LICENSURE IN FLORIDA AND OTHER JURISDICTIONS Issue Descriptin Natinally, the pl f dentists t serve a grwing ppulatin f Americans is shrinking. State bards f dentistry, licensure statutes, and rules can affect the ppulatin f eligible dental prviders available in a state and sme states have amended licensure regulatins t attract dentists. Examples f sme f these cmmn practices are: allwing freign dental schl graduates wh cmplete U.S. dental residencies t meet eligibility requirements fr licensure; cnveying reciprcity r licensure by credentials; granting special licenses; r prviding incentives (e.g., limiting liability) fr dentists wh wrk in public health/safety net clinics. Flrida is ne f fur states and the U.S. Virgin Islands that des nt grant an unrestricted dental license by credentials (grant reciprcity). The dental licensure requirements in Flrida impse additinal educatinal requirements n certain freign-trained dentists, ntwithstanding an active license t practice dentistry in anther state. Senate prfessinal staff reviewed the requirements fr btaining a license t practice dentistry in Flrida, including licensure fr freign-trained dentists; cmpared thse prvisins t ther states licensing prvisins; examined relevant literature; and interviewed agency staff and stakehlders t determine whether there is a need r a benefit t ur residents t make it mre accessible fr freign-trained dentists and dentists licensed in ther states t practice in Flrida. Backgrund Flrida Licensure Requirements If a persn desires t practice dentistry in Flrida, he r she must btain a license t practice dentistry issued under ch. 466, F.S., relating t Dentistry, Dental Hygiene, and Dental Labratries (the Dental Act). The Dental Act requires each applicant t submit an applicatin and fees, meet certain educatin requirements in rder t take the dental licensure examinatin, and successfully cmplete the dental licensure examinatin requirements. Educatin Requirements In Flrida, in rder t apply t take the required dental licensure examinatins, the applicant must be 18 years f age r lder and must have graduated frm, r is in his r her final year at, a dental schl accredited by the American Dental Assciatin Cmmissin n Dental Accreditatin (CODA) 1 r any ther dental accrediting entity 2 recgnized by the U.S. Department f Educatin. 3 By reciprcal agreement, prgrams that are accredited by the Cmmissin n Dental Accreditatin f Canada are recgnized by the CODA. 4 1 The CODA, established in 1975, is natinally recgnized by the U.S. Department f Educatin t accredit dental and dental-related educatin prgrams cnducted at the pst-secndary level. The CODA functins independently and autnmusly in matters f develping and apprving accreditatin standards, making accreditatin decisins n educatinal prgrams and develping and apprving prcedures that are used in the accreditatin prcess. The American Dental Assciatin, Dental Educatin: Schls & Prgrams, available at: (Last visited July 15, 2011). 2 Accreditatin is a nn-gvernmental, vluntary peer review prcess by which educatinal institutins r prgrams may be granted public recgnitin fr cmpliance with accepted standards f quality and perfrmance. Specialized accrediting agencies exist t assess and verify educatinal quality in particular prfessins r ccupatins t ensure that individuals will

2 Page 2 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Under Flrida law, if an applicant is a graduate f a dental cllege r schl nt accredited by CODA r f a dental cllege r schl nt apprved by the bard (e.g. freign-trained dentist), the applicant is nt entitled t take the examinatins until he r she cmpletes additinal educatinal requirements. The applicant must cmplete a prgram f study at an accredited American dental schl and must demnstrate receipt f a Dctr f Dental Surgery degree (D.D.S.) r Dctr f Dental Medicine degree (D.M.D.) frm that schl, r must cmplete a 2- year supplemental dental educatin prgram at an accredited dental schl and receive a dental diplma, degree, r certificate as evidence f prgram cmpletin. 5 In the U.S., there are currently 56 accredited dental schls. At present, Flrida has tw accredited dental schls ne public and ne private that prduced 182 graduates in The schls are the University f Flrida Cllege f Dentistry (UFCD) and Nva Sutheastern University Cllege f Dental Medicine (Nva). 7 The Lake Erie Cllege f Ostepathic Medicine plans n pening a Schl f Dental Medicine at the Bradentn campus in The prgram has received initial CODA accreditatin. 8 Recently, the University f Central Flrida, Flrida Atlantic University, and Flrida A&M University have expressed an interest in establishing their wn dental educatinal prgrams. 9 Additinally, there are 3 accredited pediatric dental residency prgrams in Flrida that prduce 14 graduates each year Nva (6 graduates), UFCD (5 graduates), and Miami Children s Hspital (3 graduates). 10 Flrida Educatinal Prgrams fr Internatinally Educated Dentists Flrida s tw accredited dental schls have Internatinal Dentist Prgrams (IDPs), which are prgrams that ffer qualified graduates f freign dental prgrams the pprtunity t earn a dental degree recgnized in the U.S. 11 The UFCD ffers tw prgrams fr dental graduates frm freign cuntries: 1) a 2-year Advanced Educatin in General Dentistry (AEGD) prgram which awards a certificate and 2) a 4-year D.M.D. prgram fr internatinally-educated dentists. be qualified t enter thse disciplines. A specialized accrediting agency recgnizes the curse f instructin which cmprises a unique set f skills and knwledge, develps the accreditatin standards by which the educatinal prgrams are evaluated, cnducts evaluatin f prgrams, and publishes a list f accredited prgrams that meet the natinal accreditatin standards. Accreditatin standards are develped in cnsultatin with thse affected by the standards. Cmmissin n Dental Accreditatin, Accreditatin Standards fr Dental Educatin Prgrams, available at: (Last visited n July 15, 2011). 3 Sectin (2), F.S. See als ch , L.O.F. 4 American Dental Assciatin, Internatinal Licensure Frequently Asked Questins, available at: (Last visited n August 2, 2011). 5 Sectin (3), F.S. and rule 64B , F.A.C. Rule 64B (2)(a), F.A.C., requires the supplemental dental educatin prgram t be a full-time, matriculated, American Dental Assciatin recgnized dental specialty educatin prgram accredited by the CODA r a CODA accredited supplemental general dentistry prgram, which prvides didactic and clinical educatin t the level f an accredited D.D.S. r D.M.D. prgram, either f which have a duratin f at least tw cnsecutive academic years at the spnsring institutin. 6 Flrida Department f Health, Health Practitiner Oral Healthcare Wrkfrce Ad Hc Cmmittee Reprt (February 2009), available at: (Last visited n July 18, 2011). 7 America Dental Assciatin, Dental Educatin Prgram Search, available at: (Last visited n July 19, 2011). 8 Lake Erie Cllege f Ostepathic Medicine, Schl f Dental Medicine, available at: (Last visited n July 19, 2011). 9 Wilmath, Kim, St. Petersburg Times, Flrida universities flat new dental schls, but are they needed?, July 10, 2011, available at: (Last visited n July 27, 2011). 10 Supra nte American Dental Assciatin, Supplemental Prgrams fr Internatinal Dentists, July 2009, available at: (Last visited n July 20, 2011). At least 14 ther states ffer supplemental educatinal prgrams fr freign-trained dentists.

3 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Page 3 AEGD Prgram A class f 12 students enrlls nce yearly in May and selected applicants will be invited t a 2-day interview prcess. Minimum admissin requirements are: prf f U.S. citizenship r a permanent resident visa; a 4-year dental degree frm a freign cuntry, which must be translated and certified by Educatinal Credential Evaluatrs in a Curse-by-Curse evaluatin reprt with a grade pint average (GPA); Test f English as a Freign Language (TOEFL) examinatin with a minimum scre f 213 (cmputer-based), 80 (internet-based), r 550 (paper-based); tw letters f recmmendatin; a wrd persnal statement including the applicant s clinical experience, persnal activities and future prfessinal gals; and successful cmpletin f the Natinal Bard Dental Examinatins Part I and Part II within 7 years f applicatin t the AEGD prgram. Preference in admissin is given t residents f Flrida. Estimated tuitin and fees per semester is $18, D.M.D. Prgram Applicatins t the 4-year D.M.D. prgram are available thrugh the Centralized Applicatin fr Advanced Placement fr Internatinal Dentists (CAAPID). Students in this prgram cmplete the entire D.M.D. prgram and are awarded a D.M.D. degree. Up t tw internatinal dentists may enrll in this prgram each fall and the applicatin deadline is December 1 annually. Minimum admissin requirements are a dental degree frm a freign cuntry, which must be translated and certified by Educatinal Credential Evaluatrs in a Curse-by- Curse evaluatin reprt with a GPA; TOEFL examinatin with a minimum scre f 80 (internet-based); tw letters f recmmendatin; a wrd persnal statement including the applicant s clinical experience, persnal activities and future prfessinal gals; and successful cmpletin f the Natinal Bard Dental Examinatins Part I. Preference in admissin is given t residents f the state f Flrida. Tuitin and fees fr this prgram are the same as the regular University f Flrida, Cllege f Dentistry tuitin and fees, which is $30,936 annually fr Flrida residents and $57,416 annually fr nn-residents. 13 The Internatinal Dental Graduate Prgram (IDG) at Nva is a 3-year prgram designed t enable qualified graduates frm nn-u.s. dental schls t earn a D.M.D. degree in the United States. Nva selects students based n academic recrds, letters f evaluatin, a cmputer generated scre f 80 in the TOEFL, a suggested minimum scre f 85 n part 1 f the Natinal Bard Dental Examinatin, a translated GPA f the American equivalent f a 3.0, a clinical case presentatin, and a psychmtr bench test. 14 The admissin prcess is highly selective, and the applicant must submit materials t Nva Sutheastern University Enrllment Prcessing Services (EPS), n later than February 15th. In rder t qualify, the applicant must have received prir t matriculatin in this Internatinal Dental Graduate Prgram, a D.M.D., D.D.S. degree, r their dcumented equivalent frm a nn-u.s. dental schl. Tuitin fr is $53,850 fr bth in-state and ut-f-state students and additinal fees are required f all students. 15 Certificatin f Freign Educatinal Institutins Sectin , F.S., authrizes freign educatinal institutins t apply fr certificatin frm the DOH as an institutin that is reasnably cmparable t that f similar accredited institutins in the United States and adequately prepares students fr the practice f dentistry. 16 Dentists wh have been trained at, and graduated 12 University f Flrida, Cllege f Dentistry, Admissins, Advanced Educatin in General Dentistry, available at: (Last visited n July 25, 2011). 13 University f Flrida, Cllege f Dentistry, Fur-Year DMD Prgram, available at: (Last visited n July 25, 2011). See als University f Flrida, Cllege f Dentistry, Admissins, Cst f Attendance, available at: (Last visited n July 25, 2011). 14 The applicant must pay a $2,500 fee t take the psychmtr bench test. Nva Sutheastern University, Cllege f Dental Medicine, Internatinal Prgram: Admissin Requirements, available at: (Last visited n July 25, 2011). The psychmtr bench test may cnsist f a wax carving examinatin, typdnt tth preparatin and restratin in amalgam, and typdnt tth preparatin fr a full metal crwn. Psychmtr tests assess hand-eye crdinatin, precisin, and aiming skills. 15 Nva Sutheastern University, Cllege f Dental Medicine, Internatinal Prgram: Tuitin and Fees, available at: (Last visited n July 25, 2011). 16 Sectin (4), F.S.

4 Page 4 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins frm, these certified institutins are nt subject t the additinal educatin requirements under s , F.S. Hwever, t date, n freign educatinal institutin has applied fr r received such certificatin by the DOH. 17 Flrida Dental Exam The Flrida Bard f Dentistry (Bard) administers the Flrida dental licensure exams. The Bard sets the number, dates, and lcatins f exams. Licensure examinatins are given at least twice a year depending n the prjected candidate ppulatin. 18 Applicants fr examinatin r re-examinatin must have taken and successfully cmpleted the Natinal Bard f Dental Examiner s dental examinatin (Natinal Bards). 19 Each applicant is required t cmplete the examinatins as prvided fr in s , F.S. The examinatins fr dentistry cnsist f: A written examinatin n the state s laws and rules regulating the practice f dentistry; 20 A practical r clinical examinatin, 21 cnsisting f fur parts: Part 1-requires a preparatin prcedure and a restratin prcedure. Part 2-requires demnstratin f peridntal skills n a patient t include definitive debridement (rt planing, deep scaling/remval f subgingival calculus, and remval f plaque, stain and supragingival calculus). Part 3-requires demnstratin f enddntic skills n specified teeth. Part 4-requires demnstratin f prsthetics skills t include the preparatin fr a 3-unit fixed partial denture n a specified mdel and the preparatin f an anterir crwn; and A diagnstic skills examinatin. 22,23 If an applicant fails t achieve a final grade f 75 percent r better n each f the fur parts f the practical r clinical examinatin, the applicant is required t retake nly that part that the applicant has failed. 24 The applicant fr licensure must successfully cmplete all three exams within a 13-mnth perid in rder t qualify fr licensure. If the candidate fails t successfully cmplete all three examinatins within the alltted timeframe, then the candidate must retake all three f the examinatins. Additinally, all examinatins are required t be cnducted in English. 25 There are tw fees assciated with the licensure examinatin $1,845 t the testing service Nrth East Reginal Bard f Dental Examiners, Inc. (NERB) fr the natinal exam fee and $650 t the Department f Health fr the applicatin, exam, and licensure fees. 26 Additinally, the applicant must supply any live patients and assume all assciated csts t ensure the patients are present at the exam. Fr applicants wh have nt taken the Natinal Bards within the last 10 years (e.g. a licensed dentist frm anther state wh may have been in practice fr 10 years r mre), he r she must als retake Part II f the Natinal Bards. 17 Infrmatin received during prfessinal staff s interview with a DOH representative n July 20, Flrida Department f Health, Divisin f Medical Quality Assurance, Bard f Dentistry, Applicatin Deadlines and Exam Dates, available at: (Last visited n July 22, 2011). 19 Rule 64B , F.A.C. 20 A final grade f 75 r better is required t pass the written examinatin. See rule 64B (2)(b), F.A.C. 21 The practical r clinical exam requires the applicant t prvide a patient wh is at least 18 years f age and whse medical histry is cnsistent with that prescribed by the bard in rder fr patients t qualify as a patient fr the examinatin. See rule 64B (3)(a), F.A.C. But see ch , L.O.F., effective Octber 1, 2011, which requires the practical r clinical examinatin t be the American Dental Licensing Examinatin (ADLE). 22 The Diagnstic Skills Examinatin is an bjective type f examinatin, where the applicant must demnstrate the ability t diagnse cnditins within the human ral cavity and its adjacent tissues and structures frm phtgraphs, slides, radigraphs, r mdels. See rule 64B (4)(a), F.A.C. 23 But see s. 9, ch , L.O.F., effective Octber 1, 2011, which prvides that the required diagnstic skills examinatin is t be included within the ADLE. 24 Rule 64B (3)(g), F.A.C. But see s (2), F.S. 25 Rule 64B , F.A.C. 26 Flrida Department f Health, Divisin f Medical Quality Assurance, Bard f Dentistry, License Fees, available at: (Last visited n July 22, 2011).

5 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Page 5 In the 2011 general legislative sessin, the Legislature enacted HB 1319 (ch , L.O.F.), which substantially refrmed the practical and clinical dental examinatin requirements in Flrida t make licensure in Flrida mre accessible fr thse wh have taken the American Dental Licensing Examinatin (ADLE) utside f Flrida. The legislative intent behind this change was t imprve access t dental care fr underserved citizens f Flrida and further the ecnmic develpment gals f Flrida. The new law is effective Octber 1, 2011, and authrizes an applicant fr licensure t submit his r her passing scres n the ADLE administered in a jurisdictin ther than Flrida in rder t satisfy the practical r clinical examinatin and diagnstic skills requirements in Flrida. The applicant must have cmpleted the examinatin after Octber 1, If the applicant s ADLE results were published mre than 365 days prir t the applicatin fr licensure, then the applicant must satisfy numerus additinal criteria in rder fr the DOH t recgnize the examinatin results. In additin, a dentist that used an ADLE scre frm anther jurisdictin t btain licensure in Flrida must, t maintain such licensure, be engaged in the full-time practice f dentistry inside the gegraphic bundaries f Flrida within 1 year f being licensed in Flrida. 27 Reciprcity f Dental Licensure Dental bards in 46 states plus the District f Clumbia and Puert Ric grant licenses t dentists, currently licensed and in active, cntinuus practice fr a specified perid f time (typically 5 years) in anther jurisdictin, withut further theretical and clinical examinatin. The license recgnitin system, ften referred t as licensure by credentials, may als be referred t as licensure by reciprcity, endrsement, r criteria. 28 In granting licensure by credentials, the bard f dentistry makes a determinatin that the applicant is currently licensed in a state that has equivalent licensure standards. Technically, licensure by reciprcity refers t a situatin in which a jurisdictin has statutry authrity t grant licensure recgnitin nly t licensees f states that grant similar recgnitin t licensees frm the receiving jurisdictin. Jurisdictins that have reciprcity agreements between state dental bards are indicated by an asterisk (*). The dental bards in the fllwing jurisdictins will grant license recgnitin t dentists: 29 Alabama Maine Oregn, Alaska Maryland 30 Oklahma Arkansas Massachusetts* Pennsylvania* Arizna Michigan Puert Ric Califrnia Minnesta Rhde Island Clrad Mississippi* Suth Carlina Cnnecticut Missuri Suth Dakta District f Clumbia* Mntana Tennessee Gergia 31 Nebraska Texas Idah New Hampshire Utah Illinis New Jersey* Vermnt Indiana New Mexic Virginia Iwa New Yrk Washingtn Kansas Nrth Carlina 32 West Virginia Kentucky Nrth Dakta Wiscnsin Luisiana Ohi Wyming 27 See ch , L.O.F., available at: (Last visited n July 27, 2011). 28 American Dental Assciatin and American Student Dental Assciatin, Dental Bards and Licensure: Infrmatin fr the New Graduate, Octber 2007, available at: (Last visited n July 28, 2011). 29 Id. 30 Maryland requires applicants fr licensure by credentials t successfully cmplete the Nrtheast Reginal Examining Bard s Dental Simulated Clinical Exercise (DSCE). 31 Gergia requires credentialed dentists t establish active practices within a certain time perid. 32 Nrth Carlina requires credentialed dentists t establish active practices within a certain time perid.

6 Page 6 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Fur states and the U.S. Virgin Islands d nt currently grant licensure by credentials: Delaware, Flrida, Hawaii, and Nevada. Hwever, in 2004 Hawaii enacted a cmmunity service license law which allws dentists with prper credentials t cme t Hawaii t wrk in federally qualified health centers, native Hawaiian health centers, and pst-secndary dental training prgrams nly. Nevada passed a licensure by credential law in 2001 that sunset at the end f June Nevada will nly issue a license after the applicant fr dental r dental hygiene licensure passes the Nevada clinical bard exam r has passed the Western Reginal Examining Bard (WREB) exam within the past 5 years. 33 The American Dental Assciatin (ADA) Huse f Delegates strngly supprts freedm f mvement thrugh licensure by credentials. A 2002 reslutin amended the ADA Guidelines fr Licensure t eliminate the requirement fr a minimum f 5 years in practice in rder t be eligible fr licensure by credentials, simply stating that a dentist shuld be in active practice r dental educatin immediately prir t applying fr licensure by credentials. 34 Other States Licensing Requirements fr Freign-Trained Dentists State bards f dentistry, licensure statutes, and rules can affect the ppulatin f eligible dental prviders available in a state and sme states have amended licensure regulatins t attract dentists. Examples f sme f these cmmn practices are: allwing freign dental schl graduates wh cmplete U.S. dental residencies t meet eligibility requirements fr licensure; cnveying reciprcity r licensure by credentials; granting special licenses; r prviding incentives (e.g., limiting liability) fr dentists wh wrk in public health/safety net clinics. 35 Minnesta, Cnnecticut, Arkansas, Mississippi, and Califrnia have develped prgrams t utilize freign-trained dentists as dentists and dental hygienists in facilities that care fr special needs patients and public health settings. 36 Belw is a table f states and U.S. territries with their crrespnding educatinal requirements fr licensure f freign-trained dentists. 37 State Alabama Alaska Arizna Arkansas Califrnia Clrad Cnnecticut Delaware Requires 2 years f pre-dctral educatin that results in a D.D.S. r D.M.D. degree Requires 2 years f pstdctral educatin Table 1 Accepts 12- mnth advanced educatin prgram (AEGD, GPR) in general dentistry Accepts 2 years f pre-r pstdctral educatin Requires graduatin frm an accredited prgram with a D.D.S. r D.M.D. degree 33 Supra nte Id. 35 Supra nte Id. 37 These state educatinal requirements are current as f July Many f these states have additinal educatin requirements. A mre detailed list f the state educatin requirements is available at: (Last visited n July 26, 2011).

7 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Page 7 District f Clumbia Flrida Gergia Hawaii Idah Illinis Indiana Iwa Kansas Kentucky Luisiana Maine Massachusetts Maryland (pediatric dentistry nly) Michigan Minnesta Mississippi Missuri Mntana Nebraska Nevada New Hampshire New Jersey New Mexic New Yrk Nrth Carlina Nrth Dakta Ohi Oklahma Oregn Pennsylvania Puert Ric Rhde Island Suth Carlina Suth Dakta Tennessee Texas Utah Vermnt Virginia

8 Page 8 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Virgin Islands Washingtn West Virginia Wiscnsin Wyming *This table has been adapted frm infrmatin prvided by the American Dental Assciatin. In 1997, Califrnia enacted a law (Assembly Bill 1116) that prvided the Califrnia dental bard with the authrity t determine whether unaccredited internatinal dental prgrams are equivalent t similar accredited institutins in the U.S. The law enabled the dental bard t apprve dental educatin prgrams utside the U.S. 38 Fllwing enactment f Califrnia s law, the Universidad De La Salle Baji in the city f Len, Mexic, applied t Califrnia s bard f dentistry fr apprval f its 5-year predctral dental educatin prgram. The Califrnia bard f dentistry granted prvisinal apprval t Universidad De La Salle in August 2002 after the first site visit. Fllwing its secnd site visit, De La Salle s 5-year pre-dctral dental educatin prgram received full certificatin in Nvember The Cllege f Dental Surgery in Manipal, India, was als evaluated fr bard apprval. Students wh are admitted t the De La Salle s Califrnia-apprved track prgram are required t sign a disclaimer stating that they knw this prgram is nt CODA-apprved. They are als infrmed that they will nly qualify t get a license t practice in Califrnia nce all licensure requirements fr the state f Califrnia are met. 39 The Universidad De La Salle als applied fr apprval frm Califrnia s bard f dentistry fr its 2-year internatinal prgram in The 2-year prgram allws freign-trained dentists t cmplete a 2-year prgram similar t thse ffered by mst states requiring 2 years f additinal educatin prir t licensure in their states. Hwever, under this prgram, the students culd nly seek licensure in Califrnia. The cst f Universidad De La Salle s Internatinal Dental Studies Prgram is $21,000 per semester, which ttals $84,000 in tuitin fr the 2-year prgram. 40 State Lan Frgiveness Prgrams Several states ffer lan frgiveness incentives in rder t recruit dentists and entice dentists t serve underserved ppulatins. Belw is a table 41 f states that have lan frgiveness prgrams at the state level (there are als several federal gvernment lan frgiveness prgrams). These states ften require a dentist t cmmit t serve a certain amunt f time in a designated area r a percentage f a designated ppulatin in the state befre a specified amunt f the dentist s lan is paid. Table 2 States Requiring Practice Time Cmmitment Amunt f Lan Frgiveness in Health Prfessinal Shrtage Areas r Other Designated Areas t Qualify fr Student Lan Frgiveness Prgrams Alabama 2-year cntract Up t $35,000 per year f service 38 American Dental Assciatin, ADA News: Internatinal dental prgram in Mexic raises questins, available at: (Last visited n July 20, 2011). 39 Id. 40 American Dental Assciatin, ADA News: Csts f De La Salle vs. ther IDPs in Califrnia, available at: (Last visited n July 22, 2011). 41 Infrmatin included in the table is adapted frm infrmatin prvided frm the American Dental Assciatin, Dental Student Lan Repayment Prgrams & Resurces, March 2011, available at: (Last visited n August 2, 2011).

9 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Page 9 Alaska 2 years Up t $35,000 per year f service Arizna Minimum f 2 years Award varies based upn the type f prvider and pririty ranking f the service site Arkansas Minimum f 2 years $60,000 fr a tw-year cntract Califrnia Minimum f 2 years and maximum f 4 years Maximum award is $120,000 fr 4 years f service Clrad 2 years Up t $70,000 fr 2 years f service (One-half f the award must cme frm the cmmunity in which the prvider practices) Cnnecticut Minimum f 2 years Up t $45,000 fr 2 years f service District f Clumbia Minimum f 2 years with an ptin t serve 2 additinal years Delaware Minimum f 2 years and maximum f 3 years (cntractual agreement) Illinis Maximum f 4 years (Tw 2- year grants allwed) Maximum award is $120,000 fr 4 years f service Up t $70,000 fr a 2-year cmmitment r up t $105,000 fr a 3-year cmmitment Up t $25,000 per year f service Indiana 2 years $40,000 fr 2 years f service Iwa 2 years Up t $30,000 per year. Kansas Minimum f 2 years Up t $30,000 per year Kentucky 2 years Up t $35,000 per year Luisiana Minimum f 2 years and maximum f 3 years Up t $13,333 per year fr a 2-year cmmitment r up t $20,000 per year fr a 3-year cmmitment Michigan 2-year cntract Up t $25,000 per year Maine 2-year cntract r mre $25,000 depending n adequate funding and cntinued area designatin Maryland Minimum f 2 years and Up t $99,000 ver a 3-year perid maximum f 4 years Massachusetts 2-year cntract Up t $25,000 per year with a maximum award f $50,000 fr a 2-year cntract Minnesta Nebraska Minimum f 3 years and maximum f 4 years One year fr each year f student lans Up t $25,000 per year, nt t exceed $100,000 ver a 4-year perid Up t $40,000 per year Nevada 2 years Each applicatin is evaluated individually and awards are made based upn the funding available during the prgram s funding cycle New Hampshire New Jersey 3-year cntract (full-time service) r 2-year cntract (part-time service) Minimum f 2 years and maximum f 4 years $75,000 fr a minimum service bligatin f 36 mnths with an pprtunity f an extensin fr an additinal 24 mnths at $40,000 Up t $21,600 fr first full year, up t $31,200 fr secnd full year, up t $33,600 fr third full year, and up t $33,600 fr the furth full year f service Nrth Carlina 4 years Up t $70,000 fr a 4-year cmmitment

10 Page 10 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Nrth Dakta 4 years Up t $80,000 fr a 4-year cmmitment Ohi 2-year cntract Up t $25,000 per year Oklahma Minimum f 2 years and Up t $25,000 per year maximum f 5 years Pennsylvania Minimum f 3 years and Up t $64,000 fr 3 r 4 years f service. maximum f 4 years Rhde Island 2 years Up t $35,000 per year f service Suth Dakta Minimum f 2 years Texas Vermnt 12 cnsecutive mnths. A match prgram is available fr 24 mnth cmmitments. Minimum 1 year service cmmitment Up t $10,000 fr 12 cnsecutive mnths f service Up t $20,000 per year Virginia 1-year cntract The lan repayment award is equivalent t 1 year f in-state tuitin and mandatry fees at Virginia Cmmnwealth University Schl f Dentistry fr the year that the lan was acquired. Washingtn Minimum f 3 years Up t $25,000 per year f service West Virginia Minimum f 2 years and maximum f 4 years $40,000 fr a 2-year cmmitment and up t $25 per each additinal year Wiscnsin 3 years Up t $50,000 ver a 3 year perid Wyming Minimum f 3 years Up t $30,000 per year *This table has been adapted frm infrmatin prvided by the American Dental Assciatin. Flrida, Gergia, Hawaii, New Yrk, Oregn, Suth Carlina, Tennessee, and Utah participate in the Natinal Health Service Crps (NHSC) Lan Repayment Prgram. 42 The NHSC Lan Repayment Prgram ffers fully trained primary care physicians, family nurse practitiners, certified nurse midwives, physician assistants, dentists, dental hygienists, and certain mental health clinicians $60,000 t repay student lans in exchange fr 2 years serving in a cmmunity-based site in a high-need Health Prfessinal Shrtage Area 43 (HPSA) that has applied t and been apprved by the NHSC as a service site. After cmpleting their 2 years f service, lan repayrs may apply fr additinal years f supprt. The lan repayment prgram recruits bth clinicians just cmpleting training and seasned prfessinals t meet the immediate need fr care thrughut the U.S. 44 New Mexic nt nly participates in the NHSC Lan Repayment Prgram, but it als ffers a $5,000 tax credit t dentists licensed in New Mexic and practicing in rural r underserved areas. 45 Sectin , F.S., establishing the Flrida Health Services Crps (FHSC), authrizes dental schlarships fr students wh agree t accept an assignment in a public health care prgram r wrk specifically in a medically underserved area. If assigned t an underserved area, the dentist must treat Medicaid patients and ther patients with lw incmes. The FHSC prgram authrizes lan repayment assistance fr certain allpathic and stepathic 42 American Dental Assciatin, Dental Student Lan Repayment Prgrams & Resurces, March 2011, available at: (Last visited n August 2, 2011). 43 Health Prfessinal Shrtage Areas (HPSAs) are designated by the federal Health Resurces and Services Administratin (HRSA) as having shrtages f primary medical care, dental r mental health prviders and may be gegraphic (a cunty r service area), demgraphic (lw incme ppulatin) r institutinal (cmprehensive health center, federally qualified health center r ther public facility). U.S. Department f Health & Human Services, Health Resurces and Services Administratin, Find Shrtage Areas: HPSA by State & Cunty, available at: (Last visited n August 2, 2011). 44 U.S. Department f Health & Human Services, Natinal Health Service Crps, Abut the NHSC: Lan Repayment, available at: (Last visited n August 2, 2011). 45 Supra nte 42.

11 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Page 11 physicians. During the 2007 Legislative Sessin, bills passed t add dentists t the lan repayment prgram and apprpriate $700,000 fr the dental student lan repayment prgram, with prvis language t implement marketing strategies at bth dental schls. Hwever, the Gvernr veted the bill including these prvisins and the apprpriatins. 46 Flrida Recruitment Initiatives Since 2008, the Flrida Legislature has made effrts t recruit dentists frm ther states. In 2008, the Legislature established the health access license in rder t attract ut-f-state dentists t practice in underserved health access settings 47 in Flrida. 48 With this license, a dentist actively licensed in gd standing in anther state, the District f Clumbia, r a U.S. territry, is authrized t practice dentistry in Flrida in a health access setting if the dentist: Files a Bard-apprved applicatin and pays the applicable fees, Has nt been cnvicted r pled nl cntendre t, regardless f adjudicatin, any felny r misdemeanr related t the practice f a health care prfessin, Submits prf f graduatin frm a dental schl accredited by the CODA, Submits dcumentatin that the dentist has cmpleted, r will btain prir t licensure, a cntinuing educatin equivalent t Flrida s requirement fr dentists fr the last full reprting biennium befre applying fr a health access license, Submits prf f her r his successful cmpletin f parts I and II f the Natinal Bards and a state r reginal clinical dental license examinatin that the Bard has determined effectively measures the applicant s ability t practice safely, Has never had a license revked frm anther state, the District f Clumbia, r a U.S. territry, Has never failed an exam under s , F.S., unless the applicant was reexamined and received a license t practice in Flrida, Has nt been reprted t the Natinal Practitiner Data Bank, 49 unless the applicant successfully appealed t have his r her name remved frm the data bank, and Submits prf that he r she has been engaged in the active, clinical practice f dentistry prviding direct patient care fr 5 years immediately preceding the date f applicatin, r prf f cntinuus clinical practice prviding direct patient care since graduatin if the applicant graduated less than 5 years frm his r her applicatin. Accrding t staff at the DOH, 7 dental health access licenses were granted in FY , while 10 were granted in FY , and 15 were granted in FY See CS/SB 1116 (2007), available at: (Last visited n August 3, 2011). See als SB 2800 (2007) cdified as ch , L.O.F., pg. 122, available at: (Last visited n August 3, 2011). 47 A health access setting is defined under s (14), F.S., as prgrams and institutins f the Department f Children and Family Services, the Department f Health, the Department f Juvenile Justice, nnprfit cmmunity health centers, Head Start centers, federally qualified health centers (FQHCs), FQHC lk-alikes as defined by federal law, and clinics perated by accredited clleges f dentistry in this state if such cmmunity service prgrams and institutins immediately reprt t the Bard f Dentistry certain vilatins r ther practice act r standard f care vilatins related t the actins r inactins f a dentist, dental hygienist, r dental assistant engaged in the delivery f dental care in such settings. 48 See ch , L.O.F., cdified in s , F.S. 49 The Natinal Practitiner Data Bank (NPDB) was established by Title IV f Public Law , the Health Care Quality Imprvement Act f 1986, as amended (Title IV). Final regulatins gverning the NPDB are cdified at 45 CFR Part 60. In 1987 Cngress passed Public Law , Sectin 5 f the Medicare and Medicaid Patient and Prgram Prtectin Act f 1987 (Sectin 1921 f the Scial Security Act), authrizing the Gvernment t cllect infrmatin cncerning sanctins taken by State licensing authrities against all health care practitiners and entities. Cngress later amended Sectin 1921 with the Omnibus Budget Recnciliatin Act f 1990, Public Law , t add any negative actin r finding by such authrity, rganizatin, r entity regarding the practitiner r entity. Respnsibility fr NPDB implementatin resides with the Bureau f Health Prfessins, Health Resurces and Services Administratin, U.S. Department f Health and Human Services. U.S. Department f Health and Human Services, Health Resurces and Services Administratin, the Data Bank, Abut Us, available at: (Last visited n August 8, 2011).

12 Page 12 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Additinally, in the 2011 general legislative sessin, the Legislature enacted ch , L.O.F., t make licensure in Flrida mre accessible fr thse wh have taken the ADLE utside f Flrida. The legislative intent behind this change was t imprve access t dental care fr underserved citizens f Flrida and further the ecnmic develpment gals f Flrida. The new law is effective Octber 1, Findings and/r Cnclusins The Dental Wrkfrce Natinally, the pl f dentists t serve a grwing ppulatin f Americans is shrinking. The ADA fund that 6,000 dentists retire each year in the U.S., while there are nly 4,000 dental schl graduates each year t replace them. The prjected shrtage f dentists is even greater in rural America. Of the apprximately 150,000 general dentists in practice in the U.S., nly 14 percent practice in rural areas, 7.7 percent in large rural areas, 3.7 percent in small rural areas, and 2.2 percent in islated rural areas. In 2003, there were 2,235 federally designated dental supply shrtage areas, 74 percent f which were lcated in nn-metrplitan areas. In cntrast, dental hygiene is predicted t be ne f the tp ten fastest grwing health care prfessins ver the next decade, grwing by a prjected 43 percent between 2006 and Cnversely, in Flrida, the wrkfrce prjectins fr dentists thrugh 2050 indicate that new dentists entering the prfessin mre than ffset attritin assciated with retirement, assuming current entry levels int the field are sustained. 52 In fact, nly an estimated 926 dentists, rughly 10 percent f Flrida s currently practicing dental wrkfrce, plan t retire within the next 5 years. In additin, 97 percent f dentists in general practice and thse having specializatins are currently accepting new patients, indicating that supply is meeting the demand fr services. Hwever, similar t the natinal trend, mst dentists in Flrida are cncentrated in the mre ppulus areas f the state, while rural areas, especially the central Panhandle cunties and interir cunties f suth Flrida, have a nticeable dearth f dentists. Thugh, it shuld be nted that 85 percent f Flrida s residents live in cunties with the best resident-t-dentist ratis. 53 Nt nly is there a shrtage f dentists in rural areas, but nly a small prtin f dentists in Flrida practice in dental public health (1.4 percent), where mst Medicaid patients are treated. Mst dentists, 74.1 percent, practice in general dentistry. 54 Additinally, there is a lack f available dental specialists 55 in many central Panhandle cunties f Flrida, thereby requiring thse wh require the services f a specialist t smetimes travel cnsiderable distances. Cnsequently, the Flrida residents wh are underserved are thse in a rural setting r thse wh are limited t seeking dental care frm dentists that prvide public health services. 50 Surpa nte Natinal Rural Health Assciatin, Issue Paper: Recruitment and Retentin f a Quality Health Wrkfrce in Rural Areas, Nvember A cpy f this reprt is n file with the Senate Health Regulatin Cmmittee. 52 Hwever, the cntinued grwth f Flrida s ppulatin and a ptential increase in the need fr dental services is nt factred int the analysis f supply and demand. The rati f Flrida residents t dentists is abut 2,016 t ne, including dentists that practice less than full-time. 53 Flrida Department f Health, Reprt n the Wrkfrce Survey f Dentists, March 2011, available at: (Last visited n July 25, 2011). Nte: In 2009, the DOH develped this wrkfrce survey fr dentists. The survey was administered n a vluntary basis in cnjunctin with biennial renewal f dental licenses and 89 percent f dentists with an active Flrida license respnded t the survey. 54 Id. 55 Types f specialists include: Orthdntics and dentfacial rthpedics, ral and maxillfacial surgery, peridntics, enddntics, pediatric dentistry, and prsthdntics.

13 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Page 13 Barriers t Dental Treatment The demgraphics and gegraphic distributin f the dental wrkfrce are nt the nly influences n the treatment f Flrida residents. Many different barriers may blck access t ral healthcare, including lack f knwledge r mtivatin, phbias, pverty, language r cultural differences, r disabilities. Pverty Accrding t the 2008 Behaviral Risk Factr Surveillance System (BRFSS) Data Reprt, annual husehld incme has a strng relatinship t the percent f adults wh visited a dentist in the past year. Amng thse adults living in husehlds with annual incmes belw $25,000, abut half saw a dentist in the past year. In cntrast, nearly 80 percent f adults with husehld incmes abve $50,000 visited a dentist. 56 In Flrida, rughly a third f the ppulatin falls within 200 percent f the Federal Pverty Level, which equates t ver six millin peple. 57 Amng the nearly 9,400 active dentists in Flrida, nly abut 1,500 (16 percent) are enrlled as Medicaid prviders and several hundred f these enrlled prviders are nt actively treating Medicaid patients. Accrding t the results f the DOH s dental wrkfrce survey, mre than 1,200 respndents (15.3 percent) reprted having a Medicaid prvider number. Amng 7,359 respndents, wh practice in private ffice settings, nly 957 (13 percent) had a Medicaid prvider number. In cntrast, apprximately 66 percent f respndents wh practice in safety net settings 58 reprted having a Medicaid prvider number. Althugh safety net respndents represent less than 5 percent f all respndents practicing in Flrida, they accunt fr mre than 18 percent f all respndents with a Medicaid prvider number. During fiscal year , a ttal f 2.1 millin children were eligible fr Medicaid services in Flrida, but less than 21 percent received a dental service paid by Medicaid. Mre than half f the dentists that respnded t the DOH dental wrkfrce survey (56 percent) cited lw cmpensatin rates 59 fr Medicaid services as the reasn fr nt accepting Medicaid. 60 Disabilities Persns with special needs, including physical disabilities, develpmental disabilities, r mental impairments, may find it difficult t find the apprpriate place fr dental services as they may need special accmmdatins. Accmmdatins ptentially include physical mdificatins f service sites, alternate services hurs, use f specific equipment r prcedures, and specialized training fr dentists. Althugh there is n data t suggest whether the special needs ppulatin is underserved, it is apparent that mre special needs patients are treated in public health r safety net settings than in private practice settings. Amng the respndents t the DOH s dental wrkfrce survey wh treated at least ne special needs patient within the past year, safety net dentists treated an average f 40 special needs patients whereas private ffice dentists treated an average f Language r Cultural Differences The ppulatin f Flrida cmprises a number f ethnic and natinality minrities, the largest f which is Hispanic. Hispanics in Flrida ttal mre than fur millin, slightly less than 22 percent f the state s ppulatin. Nearly 70 percent f Flrida s Hispanics live in five cunties: Miami-Dade (38.7 percent), Brward (10.6 percent), Orange (7.4 percent), Hillsbrugh (7.0 percent), and Palm Beach (5.7 percent). These cunties cntain large Hispanic cmmunities where Spanish is the language f daily cmmunicatin. The availability f a Spanish-speaking dentist in these areas may facilitate access t care. Currently, nly Orange and Hillsbrugh 56 See Behaviral Risk Factr Surveillance System (BRFSS), Oral Health, June 2009 Reprt, available at: (Last visited n July 25, 2011). 57 Supra nte Safety net settings include prgrams and institutins f the Department f Children and Family Services, the DOH, the Department f Juvenile Justice, nnprfit cmmunity health centers, Head Start centers, federally qualified health centers (FQHCs), FQHC lk-alikes as defined by federal law, and clinics perated by accredited clleges f dentistry. Flrida Public Health Institute, Flrida Oral Health-Infrming Plicy, available at: (Last visited n August 1, 2011). 59 Other reasns fr nt accepting Medicaid include excessive paperwrk and burdensme billing requirements. 60 Supra nte Id.

14 Page 14 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins cunties have a higher rati f Hispanic-residents-per-Hispanic-dentist cmpared t the statewide median f dentists-t-residents rati, meaning less availability f care frm a Spanish speaking dentist in these tw cunties. 62 Reciprcity f Dental Licensure Because Flrida is ne ut f fur states that des nt ffer sme frm f reciprcity fr dental licensure, Flrida may be at a disadvantage when recruiting licensed dentists frm ther states r jurisdictins. Flrida did imprve its recruitment strategy by enacting HB 1319 (ch , L.O.F.), which substantially refrmed the practical and clinical dental examinatin requirements in Flrida t make licensure in Flrida mre accessible fr thse wh have taken the American Dental Licensing Examinatin (ADLE) utside f Flrida. Hwever, this new law is still a far cry frm the reciprcity r recgnitin f licensure granted in ther states. Lan Frgiveness Prgrams Flrida is ne ut f eight states that des nt have an peratinal state-funded lan frgiveness prgram. Because ther states currently have lan assistance r lan frgiveness prgrams, thse states may have an advantage in recruiting dentists t serve lw-incme ppulatins r in rural lcatins. It may be advantageus fr Flrida t either fund its current lan repayment assistance prgram under s , F.S., r develp and implement a new lan frgiveness prgram fr dentists in rder t be cmpetitive with ther states recruiting practices. Flrida s Licensure Requirements fr Freign-Trained Dentists Freign-trained dentists are nt precluded frm seeking licensure in Flrida. Hwever, they must receive additinal educatin under s (3), F.S. Despite this additinal educatin requirement, freign-trained dentists have btained licensure in Flrida. Accrding t the results f the DOH s dental wrkfrce survey, 12.2 percent f the survey respndents graduated frm a freign dental schl r prgram. The tp five cuntries f training, in descending frequency, included: Clmbia, Cuba, India, Canada, and Mexic. 63 As demnstrated in Table 1, Flrida s licensure requirements fr freign-trained dentists are cmparable with licensure requirements in many ther states. Althugh Flrida law allws freign educatinal institutins t seek certificatin under s , F.S., in rder fr the graduates f these institutins t avid additinal educatinal requirements t receive a dental license in Flrida, n freign educatinal institutin has sught such certificatin. Accrding t a staff persn at the DOH, the lack f interest in the certificatin prgram is prbably due t the expense assciated with cntracting with cnsultants t survey and evaluate freign dental schls. In additin, applicants seeking certificatin must pay a registratin fee nt t exceed $1,000 and additinal csts up t $40,000 that the DOH expects t incur fr cnducting the certificatin survey. 64 Optins and/r Recmmendatins There is nt a state-wide shrtage f dentists in Flrida and therefre there is n general need t recruit freigntrained dentists r dentists frm ther states r jurisdictins. Hwever, despite effrts by the Legislature t incentivize dentists t practice in rural areas and serve lw-incme individuals, a shrtage in these areas is prjected t cntinue. If the Legislature is interested in pursuing additinal measures t increase the dental wrkfrce in Flrida, particularly t practice in rural areas r in public health settings and prvide services t underserved ppulatins, Senate prfessinal staff recmmends the fllwing ptins: 62 Id. 63 Id. 64 Supra nte 17. See als s (6), F.S.

15 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Page 15 Dentists Licensed in Other States r Jurisdictins: Authrize Licensure by Credentials r Reciprcity Flrida may becme mre cmpetitive in its recruitment f dentists if the Bard was authrized t determine which states have substantially similar licensing standards, including educatin and examinatin requirements, and the Bard sught reciprcity agreements fr licensure with these state dental bards. Licensure by credentials r reciprcity culd als require the dentist t have been engaged in active practice fr a perid f time immediately prir t applying fr licensure in Flrida. Expand the Health Access Dental Licensing Prgram Authrize a dentist t btain licensure thrugh the health access dental licensing prgram if the dentist agrees t serve a certain percentage f Medicaid recipients r participate in the prvider netwrk f managed care entities participating in the Medicaid prgram. Offer Lan Frgiveness r Other Lan Incentives Additinally, Flrida may becme mre cmpetitive in its recruitment f dentists in rural areas and may enhance Flrida s dental care fr underserved ppulatins if it ffers a lan frgiveness prgram. The prgram culd require dentists seeking lan assistance t serve in a rural area (the Panhandle r central, suth Flrida) and require dentists t serve a certain percentage f Medicaid recipients r participate in the prvider netwrk f managed care entities participating in the Medicaid prgram fr a particular perid f time. Cnsidering the current lack f state resurces, it may be beneficial t limit the number f dentists that may apply t the lan frgiveness prgram and target resurces t areas with the mst need fr general dentists r specialists. Furthermre, Flrida culd ffer state-guaranteed lw-interest lans, subject t available state funding, t dentists wishing t establish their wn practice. Because dentists ften have large student lans and, therefre, are nt in a financial psitin t pen their wn practice, it may encurage mre dentists t set up their practice in an underserved area, if the state wuld ffer state-guaranteed lw-interest lans fr either a 10 r 15-year perid fr the purchase f a dental ffice and dental equipment. The dentists culd be required t practice in the underserved area and serve a certain percentage f Medicaid recipients r participate in the prvider netwrk f managed care entities participating in the Medicaid prgram fr the life f the lan. After cmpletin f the lan payment, the dentist wuld becme the wner f the facility and equipment withut further bligatin. Freign-Trained Dentists: If the Legislature chses t make licensure in Flrida mre accessible fr freign-trained dentists, it may be beneficial t cuple the relaxatin f the additinal educatinal requirements with mandatry rural and public health practice, Medicaid participatin, r practice in predminately Hispanic r ther ethnic cmmunities. Incentives culd be prvided in the fllwing manner: Incentivize Rural and Public Health Practice r Medicaid Participatin Authrize freign-trained dentists t cmplete a 2-year internship under the supervisin f a Flrida-licensed dentist in a public health setting, in a rural area, serve a certain percentage f Medicaid recipients, r participate in the prvider netwrk f managed care entities participating in the Medicaid prgram fr a particular perid f time in lieu f the educatin requirement. The dentist wuld remain subject t all ther Flrida licensure requirements. At the cmpletin f the 2-year internship, the dentist wuld be eligible fr full dental licensure. This wuld help expand dental services in underserved areas and ensure the dentist receives Flrida-specific training while aviding the delay and expense f a 2-year educatinal prgram. Authrize freign-trained dentists wh have been licensed in gd standing in anther jurisdictin within the United States and actively practicing in that jurisdictin fr a certain length f time t btain a limited license fr 2 years. The dentist wuld be required t cmplete all Flrida licensure requirements except the additinal educatinal requirement and wuld be required t practice in a rural area, serve a certain percentage f Medicaid recipients, r participate in the prvider netwrk f managed care entities participating in the Medicaid prgram. After the 2 years, if there are n cmplaints r disciplinary actins against the dentist, then he r she wuld be eligible fr full dental licensure.

16 Page 16 Review Eligibility f Dentist Licensure in Flrida and Other Jurisdictins Prvide tuitin-assistance t thse freign-trained dentists subject t the additinal educatinal requirements if they agree t practice in a rural area, serve an underserved ppulatin, serve a certain percentage f Medicaid recipients, r participate in the prvider netwrk f managed care entities participating in the Medicaid prgram fr a specified amunt f time after licensure. Encurage and Incentivize Hispanic Dentists t Practice in Flrida Because Flrida has ver 4 millin Hispanics, it may be beneficial t specifically encurage and incentivize freign-trained Hispanic dentists t practice in Flrida in Hispanic-centered cmmunities. This may be accmplished by: Authrizing freign-trained, Hispanic dentists r Spanish-speaking dentists wh are licensed in gd standing in the United States and actively practicing in that jurisdictin t cmplete a 2-year internship in an Hispaniccentered cmmunity in lieu f the additinal educatin requirements under Flrida law. Hwever, the dentist wuld still be subject t all ther Flrida licensure requirements. Certifying select Hispanic dental clleges that ffer an educatinal prgram reasnably cmparable t that f similar accredited institutins in the United States and that adequately prepares its students t practice dentistry in rder fr thse students t be exempt frm the additinal educatinal requirements under Flrida law. Part f the certificatin agreement culd be fr the curriculum t encurage students pst-graduatin t serve in a Hispanic-centered cmmunity fr a certain length f time. T reduce the csts f the certificatin prcedure, the state culd utilize as much technlgy as pssible t survey certain aspects f the educatinal prgram, such as the curriculum and facilities, r rely n certificatins perfrmed by ther states.