HB 225

1	A bill to be entitled
2	An act relating to dentistry and dental hygiene; amending
3	s. 466.003, F.S.; revising the definition of the term
4	"health access setting" and defining the term "school-
5	based prevention program" for purposes of provisions
6	regulating the practice of dentistry; amending s. 466.023,
7	F.S.; revising the scope and area of practice for dental
8	hygienists; amending s. 466.0235, F.S.; revising the
9	locations at which dental hygienists may perform dental
10	charting; amending s. 466.024, F.S.; authorizing dental
11	hygienists to perform certain duties without supervision
12	or authorization by a dentist; providing exceptions;
13	requiring that dental hygienists in a health access
14	setting provide a certain disclaimer to patients before a
15	procedure is performed; providing that a health access
16	setting may bill for certain services; requiring that
17	dental hygienists provide a referral, encourage the
18	establishment of a dental home, and maintain insurance
19	coverage in specified circumstances; amending ss. 466.006
20	and 466.0067, F.S.; conforming cross-references;
21	reenacting s. 466.00672(2), F.S., relating to the
22	revocation of health access dental licenses, to
23	incorporate the amendment made by the act to s. 466.003,
24	F.S., in a reference thereto; providing an effective date.
25
26	Be It Enacted by the Legislature of the State of Florida:
27
28	Section 1.  Subsection (14) of section 466.003, Florida
29	Statutes, is amended, and subsection (15) is added to that
30	section, to read:
31	466.003  Definitions.-As used in this chapter:
32	(14)  "Health access setting settings" means a program or
33	an institution programs and institutions of the Department of
34	Children and Family Services, the Department of Health, the
35	Department of Juvenile Justice, a nonprofit community health
36	center centers, a Head Start center centers, a federally
37	qualified health center or look-alike centers (FQHCs), FQHC
38	look-alikes as defined by federal law, a school-based prevention
39	program, a clinic and clinics operated by an accredited college
40	colleges of dentistry, or an accredited dental hygiene program
41	in this state if such community service program or institution
42	programs and institutions immediately reports report to the
43	Board of Dentistry all violations of s. 466.027, s. 466.028, or
44	other practice act or standard of care violations related to the
45	actions or inactions of a dentist, dental hygienist, or dental
46	assistant engaged in the delivery of dental care in such setting
47	settings.
48	(15)  "School-based prevention program" means preventive
49	oral health services offered at a school by one of the entities
50	defined in subsection (14) or by a nonprofit organization that
51	is exempt from federal income taxation under s. 501(a) of the
52	Internal Revenue Code, and described in s. 501(c)(3) of the
53	Internal Revenue Code.
54	Section 2.  Subsections (2) and (3) of section 466.023,
55	Florida Statutes, are amended to read:
56	466.023  Dental hygienists; scope and area of practice.-
57	(2)  Dental hygienists may perform their duties:
58	(a)  In the office of a licensed dentist;
59	(b)  In public health programs and institutions of the
60	Department of Children and Family Services, Department of
61	Health, and Department of Juvenile Justice under the general
62	supervision of a licensed dentist; or
63	(c)  In a health access setting as defined in s. 466.003;
64	or
65	(d)(c)  Upon a patient of record of a dentist who has
66	issued a prescription for the services of a dental hygienist,
67	which prescription shall be valid for 2 years unless a shorter
68	length of time is designated by the dentist, in:
69	1.  Licensed public and private health facilities;
70	2.  Other public institutions of the state and federal
71	government;
72	3.  Public and private educational institutions;
73	4.  The home of a nonambulatory patient; and
74	5.  Other places in accordance with the rules of the board.
75
76	However, the dentist issuing such prescription shall remain
77	responsible for the care of such patient. As used in this
78	subsection, "patient of record" means a patient upon whom a
79	dentist has taken a complete medical history, completed a
80	clinical examination, recorded any pathological conditions, and
81	prepared a treatment plan.
82	(3)  Dental hygienists may, without supervision, provide
83	educational programs, faculty or staff training programs, and
84	authorized fluoride rinse programs; apply fluorides; instruct a
85	patient in oral hygiene care; supervise the oral hygiene care of
86	a patient;, and perform other services that which do not involve
87	diagnosis or treatment of dental conditions and that which
88	services are approved by rule of the board.
89	Section 3.  Subsection (2) of section 466.0235, Florida
90	Statutes, is amended to read:
91	466.0235  Dental charting.-
92	(2)  A dental hygienist may, without supervision and within
93	the lawful scope of his or her duties as authorized by law,
94	perform dental charting of hard and soft tissues in public and
95	private educational institutions of the state and Federal
96	Government, nursing homes, assisted living and long-term care
97	facilities, community health centers, county health departments,
98	mobile dental or health units, health access settings as defined
99	in s. 466.003, and epidemiological surveys for public health. A
100	dental hygienist may also perform dental charting on a volunteer
101	basis at health fairs.
102	Section 4.  Section 466.024, Florida Statutes, is amended
103	to read:
104	466.024  Delegation of duties; expanded functions.-
105	(1)  A dentist may not delegate irremediable tasks to a
106	dental hygienist or dental assistant, except as provided by law.
107	A dentist may delegate remediable tasks to a dental hygienist or
108	dental assistant when such tasks pose no risk to the patient. A
109	dentist may only delegate remediable tasks so defined by law or
110	rule of the board. The board by rule shall designate which tasks
111	are remediable and delegable, except that the following are by
112	law found to be remediable and delegable:
113	(a)  Taking impressions for study casts but not for the
114	purpose of fabricating any intraoral restorations or orthodontic
115	appliance.
116	(b)  Placing periodontal dressings.
117	(c)  Removing periodontal or surgical dressings.
118	(d)  Removing sutures.
119	(e)  Placing or removing rubber dams.
120	(f)  Placing or removing matrices.
121	(g)  Placing or removing temporary restorations.
122	(h)  Applying cavity liners, varnishes, or bases.
123	(i)  Polishing amalgam restorations.
124	(j)  Polishing clinical crowns of the teeth for the purpose
125	of removing stains but not changing the existing contour of the
126	tooth.
127	(k)  Obtaining bacteriological cytological specimens not
128	involving cutting of the tissue.
129
130	Nothing in This subsection does not shall be construed to limit
131	delegable tasks to those specified herein.
132	(2)  A dental hygienist licensed in this state may perform
133	the following remediable tasks in a health access setting as
134	defined in s. 466.003 without the physical presence, prior
135	examination, or authorization of a dentist:
136	(a)  Perform dental charting as defined in s. 466.0235 and
137	as provided by rule.
138	(b)  Measure and record a patient's blood pressure rate,
139	pulse rate, respiration rate, and oral temperature.
140	(c)  Record a patient's case history.
141	(d)  Apply topical fluorides, including fluoride varnishes,
142	which are approved by the American Dental Association or the
143	Food and Drug Administration.
144	(e)  Apply dental sealants.
145	(f)  Remove calculus deposits, accretions, and stains from
146	exposed surfaces of the teeth and from tooth surfaces within the
147	gingival sulcus.
148	1.  A dentist licensed under this chapter or a physician
149	licensed under chapter 458 or chapter 459 must give medical
150	clearance before a dental hygienist removes calculus deposits,
151	accretions, and stains from exposed surfaces of the teeth or
152	from tooth surfaces within the gingival sulcus.
153	2.  A dentist shall conduct a dental examination on a
154	patient within 13 months after a dental hygienist removes the
155	patient's calculus deposits, accretions, and stains from exposed
156	surfaces of the teeth or from tooth surfaces within the gingival
157	sulcus. Additional oral hygiene services may not be performed
158	under this paragraph without a clinical examination by a dentist
159	who is licensed under this chapter.
160
161	This subsection does not authorize a dental hygienist to perform
162	root planing or gingival curettage without supervision by a
163	dentist.
164	(3)  For all remediable tasks listed in subsection (2), the
165	following disclaimer must be provided to the patient in writing
166	before any procedure is performed:
167	(a)  The services being offered are not a substitute for a
168	comprehensive dental exam by a dentist.
169	(b)  The diagnosis of caries, soft tissue disease, oral
170	cancer, temporomandibular joint disease (TMJ), and dentofacial
171	malocclusions will be completed only by a dentist in the context
172	of delivering a comprehensive dental exam.
173	(4)  This section does not prevent a program operated by
174	one of the health access settings as defined in s. 466.003 or a
175	nonprofit organization that is exempt from federal income
176	taxation under s. 501(a) of the Internal Revenue Code and
177	described in s. 501(c)(3) of the Internal Revenue Code from
178	billing and obtaining reimbursement for the services described
179	in this section which are provided by a dental hygienist or from
180	making or maintaining any records pursuant to s. 456.057
181	necessary to obtain reimbursement.
182	(5)  A dental hygienist who performs, without supervision,
183	the remediable tasks listed in subsection (2) shall:
184	(a)  Provide a dental referral in strict compliance with
185	federal and state patient referral, anti-kickback, and patient
186	brokering laws.
187	(b)  Encourage the establishment of a dental home.
188	(c)  Maintain professional malpractice insurance coverage
189	that has minimum limits of $100,000 per occurrence and $300,000
190	in the aggregate through the employing health access setting or
191	individual policy.
192	(6)(2)  Notwithstanding subsection (1) or subsection (2), a
193	dentist may delegate the tasks of gingival curettage and root
194	planing to a dental hygienist but not to a dental assistant.
195	(7)(3)  All other remediable tasks shall be performed under
196	the direct, indirect, or general supervision of a dentist, as
197	determined by rule of the board, and after such formal or on-
198	the-job training by the dental hygienist or dental assistant as
199	the board by rule may require. The board by rule may establish a
200	certification process for expanded-duty dental assistants,
201	establishing such training or experience criteria or
202	examinations as it deems necessary and specifying which tasks
203	may be delegable only to such assistants. If the board does
204	establish such a certification process, the department shall
205	implement the application process for such certification and
206	administer any examinations required.
207	(8)(4)  Notwithstanding subsection (1) or subsection (2), a
208	dentist may not delegate to anyone other than another licensed
209	dentist:
210	(a)  Any prescription of drugs or medications requiring the
211	written order or prescription of a licensed dentist or
212	physician.
213	(b)  Any diagnosis for treatment or treatment planning.
214	(9)(5)  Notwithstanding any other provision of law, a
215	dentist is primarily responsible for all procedures delegated by
216	her or him.
217	(10)(6)  A No dental assistant may not shall perform an
218	intraoral procedure except after such formal or on-the-job
219	training as the board by rule shall prescribe.
220	Section 5.  Paragraph (c) of subsection (2) of section
221	466.006, Florida Statutes, is amended to read:
222	466.006  Examination of dentists.-
223	(2)  An applicant shall be entitled to take the
224	examinations required in this section to practice dentistry in
225	this state if the applicant:
226	(c)1.  Has successfully completed the National Board of
227	Dental Examiners dental examination within 10 years after of the
228	date of application; or
229	2.  Has an active health access dental license in this
230	state; and
231	a.  The applicant has at least 5,000 hours within 4
232	consecutive years of clinical practice experience providing
233	direct patient care in a health access setting as defined in s.
234	466.003 s. 466.003(14); the applicant is a retired veteran
235	dentist of any branch of the United States Armed Services who
236	has practiced dentistry while on active duty and has at least
237	3,000 hours within 3 consecutive years of clinical practice
238	experience providing direct patient care in a health access
239	setting as defined in s. 466.003 s. 466.003(14); or the
240	applicant has provided a portion of his or her salaried time
241	teaching health profession students in any public education
242	setting, including, but not limited to, a community college,
243	college, or university, and has at least 3,000 hours within 3
244	consecutive years of clinical practice experience providing
245	direct patient care in a health access setting as defined in s.
246	466.003 s. 466.003(14);
247	b.  The applicant has not been disciplined by the board,
248	except for citation offenses or minor violations;
249	c.  The applicant has not filed a report pursuant to s.
250	456.049; and
251	d.  The applicant has not been convicted of or pled nolo
252	contendere to, regardless of adjudication, any felony or
253	misdemeanor related to the practice of a health care profession.
254	Section 6.  Section 466.0067, Florida Statutes, is amended
255	to read:
256	466.0067  Application for health access dental license.-The
257	Legislature finds that there is an important state interest in
258	attracting dentists to practice in underserved health access
259	settings in this state and further, that allowing out-of-state
260	dentists who meet certain criteria to practice in health access
261	settings without the supervision of a dentist licensed in this
262	state is substantially related to achieving this important state
263	interest. Therefore, notwithstanding the requirements of s.
264	466.006, the board shall grant a health access dental license to
265	practice dentistry in this state in health access settings as
266	defined in s. 466.003 s. 466.003(14) to an applicant that:
267	(1)  Files an appropriate application approved by the
268	board;
269	(2)  Pays an application license fee for a health access
270	dental license, laws-and-rule exam fee, and an initial licensure
271	fee. The fees specified in this subsection may not differ from
272	an applicant seeking licensure pursuant to s. 466.006;
273	(3)  Has not been convicted of or pled nolo contendere to,
274	regardless of adjudication, any felony or misdemeanor related to
275	the practice of a health care profession;
276	(4)  Submits proof of graduation from a dental school
277	accredited by the Commission on Dental Accreditation of the
278	American Dental Association or its successor agency;
279	(5)  Submits documentation that she or he has completed, or
280	will obtain prior to licensure, continuing education equivalent
281	to this state's requirement for dentists licensed under s.
282	466.006 for the last full reporting biennium before applying for
283	a health access dental license;
284	(6)  Submits proof of her or his successful completion of
285	parts I and II of the dental examination by the National Board
286	of Dental Examiners and a state or regional clinical dental
287	licensing examination that the board has determined effectively
288	measures the applicant's ability to practice safely;
289	(7)  Currently holds a valid, active, dental license in
290	good standing which has not been revoked, suspended, restricted,
291	or otherwise disciplined from another of the United States, the
292	District of Columbia, or a United States territory;
293	(8)  Has never had a license revoked from another of the
294	United States, the District of Columbia, or a United States
295	territory;
296	(9)  Has never failed the examination specified in s.
297	466.006, unless the applicant was reexamined pursuant to s.
298	466.006 and received a license to practice dentistry in this
299	state;
300	(10)  Has not been reported to the National Practitioner
301	Data Bank, unless the applicant successfully appealed to have
302	his or her name removed from the data bank;
303	(11)  Submits proof that he or she has been engaged in the
304	active, clinical practice of dentistry providing direct patient
305	care for 5 years immediately preceding the date of application,
306	or in instances when the applicant has graduated from an
307	accredited dental school within the preceding 5 years, submits
308	proof of continuous clinical practice providing direct patient
309	care since graduation; and
310	(12)  Has passed an examination covering the laws and rules
311	of the practice of dentistry in this state as described in s.
312	466.006(4)(a).
313	Section 7.  For the purpose of incorporating the amendment
314	made by this act to section 466.003, Florida Statutes, in a
315	reference thereto, subsection (2) of section 466.00672, Florida
316	Statutes, is reenacted to read:
317	466.00672  Revocation of health access dental license.-
318	(2)  Failure of an individual licensed pursuant to s.
319	466.0067 to limit the practice of dentistry to health access
320	settings as defined in s. 466.003 constitutes the unlicensed
321	practice of dentistry.
322	Section 8.  This act shall take effect upon becoming a law.

CODING: Words stricken are deletions; words underlined are additions.