§1220.157. Temporary Permit for Free Dental Care

a)         A person seeking a Temporary Permit for Free Dental Care pursuant to Section 19.2 of the Act shall file an application on forms provided by the Division, that includes:

 

1)         Certification of licensure in the original jurisdiction and from any jurisdiction where the applicant has been practicing for at least one year, stating:

 

A)        The time during which the applicant was licensed in that jurisdiction, including the date of the original issuance of the license; and

 

B)        Whether the files of the jurisdiction contain any record of any disciplinary action taken or pending;

 

2)         Certification of graduation from a course of instruction in a dental school that meets the minimum education standards of the Division specified in Section 1220.140;

 

3)         Certification of licensure in another jurisdiction in which the applicant is currently licensed, stating, if applicable:

 

A)        The time during which the applicant was licensed in that jurisdiction, including the date of original issuance of the license;

 

B)        A description of the licensure examination in that jurisdiction; and

 

C)        Whether the file on the applicant contains a record of any disciplinary actions taken or pending;

 

4)         Certification of a collaborative agreement with an Illinois licensed dentist, including the name and license number of the Illinois licensed collaborating dentist;

 

5)         Certification of formal invitation to perform dental care by a charitable organization or a formal invitation to study or receive training on specific dental or clinical subjects or techniques by a licensed CE sponsor approved by the Department; and

 

6)         The fee as required under Section 1220.415.

 

b)         A continuing education sponsor seeking a license to provide live patient continuing education clinical training courses pursuant to Section 19.2(a-5) of the Act shall file an application on forms provided by the Division, that includes:

 

1)         Proof of a valid Illinois CE Sponsor License in good standing;

 

2)         Proof that the continuing education course provides services, without compensation, that will improve the welfare of Illinois residents who are eligible for Medicaid or who are uninsured and whose household income is not greater than 200% of the federal poverty level;

 

3)         A plan of follow-up care and training models;

 

4)         Any and all documentation to be signed by the patients, including but not limited to waivers, consent forms, and releases;

 

5)         Information related to the facilities being utilized, staffing plans, and emergency plans;

 

6)         The process by which patients will be contacted before, during, and after treatment;

 

7)         The intended population that will be receiving treatment in the specific continuing education course;

 

8)         Proof of valid malpractice insurance for the approved continuing education sponsor that extends coverage to clinical staff, trainees, and out-of-state permit holders;

 

9)         A valid written collaborative agreement between the temporary visiting dentists holding a permit pursuant to Section 19.2 of the Act and the Illinois licensed dentist co-treating patients under this Section; and

 

10)        A fee as required under 1220.415.

 

c)         The written collaborative agreement shall be made available upon request.  The application to the Department shall include the name and Illinois license number of the collaborating dentist, as well as the name, license number, and licensure jurisdiction of the visiting dentist.  The Department may disapprove a collaborating dentist if the Department believes a collaborating dentist is not appropriate based on previous disciplinary history or inability to properly serve as a collaborating dentist.

 

d)         The Temporary Training License will be valid for no longer than 5 consecutive clinical days within 6 months from the date of issuance and may be restored no more than one time within 5 years of the initial license’s issuance.

 

(Source:  Added at 47 Ill. Reg. 1672, effective January 23, 2023)