Florida Senate - 2011                                     SB 446
       By Senator Hays
       20-00313D-11                                           2011446__
    1                        A bill to be entitled                      
    2         An act relating to dentistry and dental hygiene;
    3         amending s. 466.003, F.S.; revising the definition of
    4         the term “health access setting” and defining the term
    5         “school-based prevention program” for purposes of
    6         provisions regulating the practice of dentistry;
    7         amending s. 466.023, F.S.; revising the scope and area
    8         of practice for dental hygienists; amending s.
    9         466.0235, F.S.; revising the locations at which dental
   10         hygienists may perform dental charting; amending s.
   11         466.024, F.S.; authorizing dental hygienists to
   12         perform certain duties without supervision or
   13         authorization by a dentist; providing exceptions;
   14         requiring that dental hygienists in a health access
   15         setting provide a certain disclaimer to patients
   16         before a procedure is performed; providing that a
   17         health access setting may bill for certain services;
   18         requiring that dental hygienists provide a referral,
   19         encourage the establishment of a dental home, and
   20         maintain insurance coverage in specified
   21         circumstances; amending ss. 466.006 and 466.0067,
   22         F.S.; conforming cross-references; reenacting s.
   23         466.00672(2), F.S., relating to the revocation of
   24         health access dental licenses, to incorporate the
   25         amendment made by the act to s. 466.003, F.S., in a
   26         reference thereto; providing an effective date.
   28  Be It Enacted by the Legislature of the State of Florida:
   30         Section 1. Subsection (14) of section 466.003, Florida
   31  Statutes, is amended, and subsection (15) is added to that
   32  section, to read:
   33         466.003 Definitions.—As used in this chapter:
   34         (14) “Health access setting settings” means a program or an
   35  institution programs and institutions of the Department of
   36  Children and Family Services, the Department of Health, the
   37  Department of Juvenile Justice, a nonprofit community health
   38  center centers, a Head Start center centers, a federally
   39  qualified health center or look-alike centers (FQHCs), FQHC
   40  look-alikes as defined by federal law, a school-based prevention
   41  program, a clinic and clinics operated by an accredited college
   42  colleges of dentistry, or an accredited dental hygiene program
   43  in this state if such community service program or institution
   44  programs and institutions immediately reports report to the
   45  Board of Dentistry all violations of s. 466.027, s. 466.028, or
   46  other practice act or standard of care violations related to the
   47  actions or inactions of a dentist, dental hygienist, or dental
   48  assistant engaged in the delivery of dental care in such setting
   49  settings.
   50         (15) “School-based prevention program” means preventive
   51  oral health services offered at a school by one of the entities
   52  defined in subsection (14) or by a nonprofit organization that
   53  is exempt from federal income taxation under s. 501(a) of the
   54  Internal Revenue Code, and described in s. 501(c)(3) of the
   55  Internal Revenue Code.
   56         Section 2. Subsections (2) and (3) of section 466.023,
   57  Florida Statutes, are amended to read:
   58         466.023 Dental hygienists; scope and area of practice.—
   59         (2) Dental hygienists may perform their duties:
   60         (a) In the office of a licensed dentist;
   61         (b) In public health programs and institutions of the
   62  Department of Children and Family Services, Department of
   63  Health, and Department of Juvenile Justice under the general
   64  supervision of a licensed dentist; or
   65         (c) In a health access setting as defined in s. 466.003; or
   66         (d)(c) Upon a patient of record of a dentist who has issued
   67  a prescription for the services of a dental hygienist, which
   68  prescription shall be valid for 2 years unless a shorter length
   69  of time is designated by the dentist, in:
   70         1. Licensed public and private health facilities;
   71         2. Other public institutions of the state and federal
   72  government;
   73         3. Public and private educational institutions;
   74         4. The home of a nonambulatory patient; and
   75         5. Other places in accordance with the rules of the board.
   77  However, the dentist issuing such prescription shall remain
   78  responsible for the care of such patient. As used in this
   79  subsection, “patient of record” means a patient upon whom a
   80  dentist has taken a complete medical history, completed a
   81  clinical examination, recorded any pathological conditions, and
   82  prepared a treatment plan.
   83         (3) Dental hygienists may, without supervision, provide
   84  educational programs, faculty or staff training programs, and
   85  authorized fluoride rinse programs; apply fluorides; instruct a
   86  patient in oral hygiene care; supervise the oral hygiene care of
   87  a patient;, and perform other services that which do not involve
   88  diagnosis or treatment of dental conditions and that which
   89  services are approved by rule of the board.
   90         Section 3. Subsection (2) of section 466.0235, Florida
   91  Statutes, is amended to read:
   92         466.0235 Dental charting.—
   93         (2) A dental hygienist may, without supervision and within
   94  the lawful scope of his or her duties as authorized by law,
   95  perform dental charting of hard and soft tissues in public and
   96  private educational institutions of the state and Federal
   97  Government, nursing homes, assisted living and long-term care
   98  facilities, community health centers, county health departments,
   99  mobile dental or health units, health access settings as defined
  100  in s. 466.003, and epidemiological surveys for public health. A
  101  dental hygienist may also perform dental charting on a volunteer
  102  basis at health fairs.
  103         Section 4. Section 466.024, Florida Statutes, is amended to
  104  read:
  105         466.024 Delegation of duties; expanded functions.—
  106         (1) A dentist may not delegate irremediable tasks to a
  107  dental hygienist or dental assistant, except as provided by law.
  108  A dentist may delegate remediable tasks to a dental hygienist or
  109  dental assistant when such tasks pose no risk to the patient. A
  110  dentist may only delegate remediable tasks so defined by law or
  111  rule of the board. The board by rule shall designate which tasks
  112  are remediable and delegable, except that the following are by
  113  law found to be remediable and delegable:
  114         (a) Taking impressions for study casts but not for the
  115  purpose of fabricating any intraoral restorations or orthodontic
  116  appliance.
  117         (b) Placing periodontal dressings.
  118         (c) Removing periodontal or surgical dressings.
  119         (d) Removing sutures.
  120         (e) Placing or removing rubber dams.
  121         (f) Placing or removing matrices.
  122         (g) Placing or removing temporary restorations.
  123         (h) Applying cavity liners, varnishes, or bases.
  124         (i) Polishing amalgam restorations.
  125         (j) Polishing clinical crowns of the teeth for the purpose
  126  of removing stains but not changing the existing contour of the
  127  tooth.
  128         (k) Obtaining bacteriological cytological specimens not
  129  involving cutting of the tissue.
  131  Nothing in This subsection does not shall be construed to limit
  132  delegable tasks to those specified herein.
  133         (2) A dental hygienist licensed in this state may perform
  134  the following remediable tasks in a health access setting as
  135  defined in s. 466.003 without the physical presence, prior
  136  examination, or authorization of a dentist:
  137         (a)Perform dental charting as defined in s. 466.0235 and
  138  as provided by rule.
  139         (b)Measure and record a patient’s blood pressure rate,
  140  pulse rate, respiration rate, and oral temperature.
  141         (c) Record a patient’s case history.
  142         (d)Apply topical fluorides, including fluoride varnishes,
  143  which are approved by the American Dental Association or the
  144  Food and Drug Administration.
  145         (e)Apply dental sealants.
  146         (f)Remove calculus deposits, accretions, and stains from
  147  exposed surfaces of the teeth and from tooth surfaces within the
  148  gingival sulcus.
  149         1. A dentist licensed under this chapter or a physician
  150  licensed under chapter 458 or chapter 459 must give medical
  151  clearance before a dental hygienist removes calculus deposits,
  152  accretions, and stains from exposed surfaces of the teeth or
  153  from tooth surfaces within the gingival sulcus.
  154         2. A dentist shall conduct a dental examination on a
  155  patient within 13 months after a dental hygienist removes the
  156  patient’s calculus deposits, accretions, and stains from exposed
  157  surfaces of the teeth or from tooth surfaces within the gingival
  158  sulcus. Additional oral hygiene services may not be performed
  159  under this paragraph without a clinical examination by a dentist
  160  who is licensed under this chapter.
  162  This subsection does not authorize a dental hygienist to perform
  163  root planing or gingival curettage without supervision by a
  164  dentist.
  165         (3) For all remediable tasks listed in subsection (2), the
  166  following disclaimer must be provided to the patient in writing
  167  before any procedure is performed:
  168         (a) The services being offered are not a substitute for a
  169  comprehensive dental exam by a dentist.
  170         (b) The diagnosis of caries, soft tissue disease, oral
  171  cancer, temporomandibular joint disease (TMJ), and dentofacial
  172  malocclusions will be completed only by a dentist in the context
  173  of delivering a comprehensive dental exam.
  174         (4) This section does not prevent a program operated by one
  175  of the health access settings as defined in s. 466.003 or a
  176  nonprofit organization that is exempt from federal income
  177  taxation under s. 501(a) of the Internal Revenue Code and
  178  described in s. 501(c)(3) of the Internal Revenue Code from
  179  billing and obtaining reimbursement for the services described
  180  in this section which are provided by a dental hygienist or from
  181  making or maintaining any records pursuant to s. 456.057
  182  necessary to obtain reimbursement.
  183         (5) A dental hygienist who performs, without supervision,
  184  the remediable tasks listed in subsection (2) shall:
  185         (a) Provide a dental referral in strict compliance with
  186  federal and state patient referral, anti-kickback, and patient
  187  brokering laws.
  188         (b) Encourage the establishment of a dental home.
  189         (c) Maintain professional malpractice insurance coverage
  190  that has minimum limits of $100,000 per occurrence and $300,000
  191  in the aggregate through the employing health access setting or
  192  individual policy.
  193         (6)(2) Notwithstanding subsection (1) or subsection (2), a
  194  dentist may delegate the tasks of gingival curettage and root
  195  planing to a dental hygienist but not to a dental assistant.
  196         (7)(3) All other remediable tasks shall be performed under
  197  the direct, indirect, or general supervision of a dentist, as
  198  determined by rule of the board, and after such formal or on
  199  the-job training by the dental hygienist or dental assistant as
  200  the board by rule may require. The board by rule may establish a
  201  certification process for expanded-duty dental assistants,
  202  establishing such training or experience criteria or
  203  examinations as it deems necessary and specifying which tasks
  204  may be delegable only to such assistants. If the board does
  205  establish such a certification process, the department shall
  206  implement the application process for such certification and
  207  administer any examinations required.
  208         (8)(4) Notwithstanding subsection (1) or subsection (2), a
  209  dentist may not delegate to anyone other than another licensed
  210  dentist:
  211         (a) Any prescription of drugs or medications requiring the
  212  written order or prescription of a licensed dentist or
  213  physician.
  214         (b) Any diagnosis for treatment or treatment planning.
  215         (9)(5) Notwithstanding any other provision of law, a
  216  dentist is primarily responsible for all procedures delegated by
  217  her or him.
  218         (10)(6)A No dental assistant may not shall perform an
  219  intraoral procedure except after such formal or on-the-job
  220  training as the board by rule shall prescribe.
  221         Section 5. Paragraph (c) of subsection (2) of section
  222  466.006, Florida Statutes, is amended to read:
  223         466.006 Examination of dentists.—
  224         (2) An applicant shall be entitled to take the examinations
  225  required in this section to practice dentistry in this state if
  226  the applicant:
  227         (c)1. Has successfully completed the National Board of
  228  Dental Examiners dental examination within 10 years after of the
  229  date of application; or
  230         2. Has an active health access dental license in this
  231  state; and
  232         a. The applicant has at least 5,000 hours within 4
  233  consecutive years of clinical practice experience providing
  234  direct patient care in a health access setting as defined in s.
  235  466.003 s. 466.003(14); the applicant is a retired veteran
  236  dentist of any branch of the United States Armed Services who
  237  has practiced dentistry while on active duty and has at least
  238  3,000 hours within 3 consecutive years of clinical practice
  239  experience providing direct patient care in a health access
  240  setting as defined in s. 466.003 s. 466.003(14); or the
  241  applicant has provided a portion of his or her salaried time
  242  teaching health profession students in any public education
  243  setting, including, but not limited to, a community college,
  244  college, or university, and has at least 3,000 hours within 3
  245  consecutive years of clinical practice experience providing
  246  direct patient care in a health access setting as defined in s.
  247  466.003 s. 466.003(14);
  248         b. The applicant has not been disciplined by the board,
  249  except for citation offenses or minor violations;
  250         c. The applicant has not filed a report pursuant to s.
  251  456.049; and
  252         d. The applicant has not been convicted of or pled nolo
  253  contendere to, regardless of adjudication, any felony or
  254  misdemeanor related to the practice of a health care profession.
  255         Section 6. Section 466.0067, Florida Statutes, is amended
  256  to read:
  257         466.0067 Application for health access dental license.—The
  258  Legislature finds that there is an important state interest in
  259  attracting dentists to practice in underserved health access
  260  settings in this state and further, that allowing out-of-state
  261  dentists who meet certain criteria to practice in health access
  262  settings without the supervision of a dentist licensed in this
  263  state is substantially related to achieving this important state
  264  interest. Therefore, notwithstanding the requirements of s.
  265  466.006, the board shall grant a health access dental license to
  266  practice dentistry in this state in health access settings as
  267  defined in s. 466.003 s. 466.003(14) to an applicant that:
  268         (1) Files an appropriate application approved by the 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 good
  290  standing which has not been revoked, suspended, restricted, or
  291  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.