Dental Pilot Project Advisory Committee Application

Thank you for your interest in serving on the Dental Pilot Project Advisory Committee.

The purpose of the Dental Pilot Project Program Advisory Committee is to provide advice to OHA regarding approved projects. OHA will convene the committee to gather its members' collective knowledge, experience, expertise, and insight to assist the OHA in meeting its responsibilities. Members will be asked to review and provide advice on the project training, protocols, progress reports and other project issues as needed throughout the duration of the pilot project. Although the committee provides advice to the agency, OHA makes all final decisions.

The committee is an interdisciplinary team composed of representatives of dental boards, professional organizations, other state regulatory bodies and interested parties that have applied to participate and assist the Authority in meeting its responsibilities. Committee members must not be involved in any way with the specific dental pilot project applicant or approved project in order to be a member of the committee.

Committee Size: The committee shall not consist of more than 15 members, except that additional members may be added by OHA. If a member resigns from the committee before the end of his or her term, OHA will accept applications for a new member.

Process for Membership: Prospective members are required to complete an application.

Member Qualifications: Members may include, but are not limited to representatives from the following entities:

Dental Care Organization(s)

Dental care providers and allied dental care professionals

Dental policy subject matter experts

Federally Qualified Health Centers

Oregon Board of Dentistry

Oregon Dental Association

Oregon Dental Hygiene Association

Oregon Dental Hygiene Education Program

Oregon Health and Sciences University (School of Dentistry)

Oregon Oral Health Coalition

Individuals representing the target population served by the pilot project

Individuals with an interest in public health, oral health or expanding access to medical and dental care

Representatives of OHP member advocate organizations

Representatives of underserved and vulnerable populations or their advocacy groups

Term of Office: The term of office for each member is two years. The term begins on date OHA notifies an individual in writing that the individual has been selected for the committee. Individuals who wish to serve additional term(s) must reapply. A committee member cannot serve more than six consecutive years.

Payment/Reimbursement: Dental Pilot Project Advisory Committee members are non-paid but eligible travel expenses will be reimbursed according to State of Oregon guidelines. Members are not allowed to accept gifts, meals, lodging, etc. provided by the sponsor of a pilot project or provided on behalf of the sponsor. Members are prohibited from contacting any staff member or sponsor of a pilot project outside of the confines of the site visits in relation to the dental pilot project activities. A member’s questions or concerns about a pilot project should be voiced during a site visit or raised with the Dental Pilot Project Program Manager.

Removal of Committee Members: OHA may remove a member who is unable to meet the responsibilities of a member or regularly attend meetings. Should committee members miss more than two committee meetings per year, they will be asked to resign from the committee.

Committee Members Expectations:

Comply with confidentiality requirements established by OHA.

Use best-practices, evidence-based and data-driven models for analysis and evaluation of issues.

Recuse oneself if there is a conflict of interest or perceived conflict of interest.

Treat all people fairly regardless of race, color, gender and ethnic origin.

Respect other points of view brought before the committee; be open to learning from one another.

Review materials as ahead of each meeting and come prepared to discuss and participate; bring issues forward for discussion in a professional and timely manner.

Respond as requested to any deadlines set by OHA.

Do not volunteer for any activity or assignment that you are not qualified for.

Do not claim to represent, speak, or write opinions of the Oregon Health Authority without prior written permission.

Report back to representative organization accurate information on the status of the pilot project.

Committee Member Responsibilities & Rules:

Attendance at all meetings unless excused by OHA

Advise OHA on:

> The efficacies of training, competencies and the collection of data

> Project protocols related to the ongoing assurance of patient safety

> The evaluation of project progress reports as needed

> Dental pilot project issues, should they arise

Participate and attend at least one site visit of a dental pilot project during each year of the pilot project

Committee operates under an email intensive environment; members are responsible for reviewing materials in a timely matter and responding as requested by deadlines.

The Oregon Health Authority fills positions at its discretion based on available space and criteria that ensures a balanced evaluative effort by proponents, opponents and neutral parties.

If your application is accepted, we will provide additional details regarding the terms of service and an explanation of the

advisory committee process.

Dental Pilot Project Advisory Committee Application

Name: Click or tap here to enter text.

Title: Click or tap here to enter text.

Organization: Click or tap here to enter text.

Address: Click or tap here to enter text.

City: Click or tap here to enter text.

State: Click or tap here to enter text.

Phone: Click or tap here to enter text.

Email: Click or tap here to enter text.

Which Advisory Committee are you applying for membership?

Choose an item.

Are you a first-time applicant or are you seeking reappointment?

Choose an item.

What is your affiliation?

Choose an item.

Please answer the following questions (attach a maximum of up to two (2) additional pages, if necessary):

In the space below, describe your interest in serving on the Dental Pilot Project Advisory Committee.

Click or tap here to enter text.

Dental Pilot Project Advisory Committee Application

In the space below, describe what strengths, contributions, and resources you would bring to the Dental Pilot Project that would make you the ideal candidate.

Click or tap here to enter text.

Signature: Click or tap here to enter text.

Date: Click or tap here to enter text.

Instructions:

Download and complete the application.

Submit this application form and a copy of your current resume or curriculum vitae via e-mail to: sarah.e.kowalski@state.or.us

If you have questions regarding the application or selection process, please contact:

Sarah Kowalski, Dental Pilot Project Coordinator sarah.e.kowalski@state.or.us.

(971) 673-1563

Oregon Health Authority-Dental Pilot Project