Florida Senate - 2018                                    SB 1498
       
       
        
       By Senator Brandes
       
       
       
       
       
       24-01111-18                                           20181498__
    1                        A bill to be entitled                      
    2         An act relating to dental therapy; amending s.
    3         409.906, F.S.; authorizing Medicaid to reimburse for
    4         dental services provided in a mobile dental unit that
    5         is owned by, operated by, or contracted with a health
    6         access setting or another similar program; amending s.
    7         466.001, F.S.; revising legislative purpose and
    8         intent; amending s. 466.002, F.S.; providing
    9         construction; amending s. 466.003, F.S.; defining the
   10         terms “dental therapy” and “dental therapist”;
   11         revising the definition of the term “health access
   12         setting” to include certain dental therapy programs;
   13         amending s. 466.004, F.S.; requiring the chair of the
   14         Board of Dentistry to appoint a Council on Dental
   15         Therapy; providing for membership, meetings, and the
   16         purpose of the council; amending s. 466.006, F.S.;
   17         revising the definition of the terms “full-time
   18         practice” and “full-time practice of dentistry within
   19         the geographic boundaries of this state within 1 year”
   20         to include full-time faculty members of certain dental
   21         therapy schools; amending s. 466.0075, F.S.;
   22         authorizing the board to require any person applying
   23         to take the examination to practice dental therapy to
   24         maintain medical malpractice insurance of certain
   25         amounts; amending s. 466.009, F.S.; requiring the
   26         Department of Health to allow any person who fails the
   27         dental therapy examination to retake it; providing
   28         that a person who fails a practical or clinical
   29         examination to practice dental therapy and who has
   30         only failed one portion or procedure of the
   31         examination may only be required to retake that
   32         portion or procedure to pass the examination; amending
   33         s. 466.011, F.S.; requiring the board to certify
   34         applicants who satisfy specified requirements for
   35         licensure by the department; providing an exception;
   36         creating s. 466.0136, F.S.; requiring the board to
   37         require each licensed dental therapist to complete a
   38         specified continuing professional education
   39         requirement; requiring the board to adopt rules and
   40         guidelines; authorizing the board to excuse licensees
   41         from continuing education requirements in certain
   42         circumstances; amending s. 466.016, F.S.; requiring a
   43         practitioner of dental therapy to post and display her
   44         or his license in each office where she or he
   45         practices; amending s. 466.017, F.S.; requiring the
   46         board to adopt certain rules relating to dental
   47         therapists; authorizing a dental therapist under the
   48         general supervision of a dentist to administer local
   49         anesthesia if specified requirements are met;
   50         authorizing a dental therapist under general
   51         supervision of a dentist to utilize an X-ray machine,
   52         expose dental X-ray films, and interpret such films,
   53         if specified requirements are met; amending s.
   54         466.018, F.S.; providing that a dentist remains
   55         primarily responsible for the dental treatment of a
   56         patient regardless of whether the treatment is
   57         provided by a dental therapist; requiring the initials
   58         of a dental therapist who renders treatment to a
   59         patient to be placed in the record of a patient;
   60         creating s. 466.0225, F.S.; providing application
   61         requirements, including the payment of a fee, for a
   62         person seeking to become licensed as a dental
   63         therapist; providing qualifications for a person to
   64         take dental therapy examinations; creating s.
   65         466.0226, F.S.; authorizing certain dental school
   66         graduates who meet certain requirements to be licensed
   67         to practice dental therapy; creating s. 466.0227,
   68         F.S.; authorizing a dental therapist to perform
   69         specified services under the general supervision of a
   70         dentist with authorization and within the terms of a
   71         written collaborative management agreement if certain
   72         criteria are met; listing dental therapy services;
   73         requiring that a collaborative management agreement be
   74         signed by a supervising dentist and a dental therapist
   75         and include certain information; authorizing a
   76         supervising dentist to restrict or limit the dental
   77         therapist’s practice in a collaborative management
   78         agreement; providing that a supervising dentist may
   79         authorize a dental therapist to provide dental therapy
   80         services to a patient before the dentist examines or
   81         diagnoses the patient; requiring that a supervising
   82         dentist be licensed and practicing in this state;
   83         specifying that the supervising dentist is responsible
   84         for certain services; amending s. 466.026, F.S.;
   85         providing criminal penalties for a person practicing
   86         dental therapy without an active license, for a person
   87         who sells or offers to sell a diploma conferring a
   88         degree from a dental therapy school or college, and
   89         for a person who falsely holds himself or herself out
   90         as an actively licensed dental therapist; amending s.
   91         466.028, F.S.; revising grounds for denial of a
   92         license or disciplinary action to include provisions
   93         relating to dental therapy; amending s. 466.0285,
   94         F.S.; prohibiting persons other than dentists from
   95         employing a dental therapist in the operation of a
   96         dental office and from controlling the use of any
   97         dental equipment in the provision of dental services
   98         in certain circumstances; amending s. 466.051, F.S.;
   99         revising a public records exemption to include
  100         personal identifying information that is contained in
  101         a record provided by a dental therapist in response to
  102         a dental workforce survey and that is held by the
  103         department; requiring the department, in consultation
  104         with the board and the Agency for Health Care
  105         Administration, to provide two progress reports to the
  106         Legislature by specified dates; requiring that certain
  107         information and recommendations be included in the
  108         reports; providing an effective date.
  109          
  110  Be It Enacted by the Legislature of the State of Florida:
  111  
  112         Section 1. Paragraph (c) of subsection (1) of section
  113  409.906, Florida Statutes, is amended to read:
  114         409.906 Optional Medicaid services.—Subject to specific
  115  appropriations, the agency may make payments for services which
  116  are optional to the state under Title XIX of the Social Security
  117  Act and are furnished by Medicaid providers to recipients who
  118  are determined to be eligible on the dates on which the services
  119  were provided. Any optional service that is provided shall be
  120  provided only when medically necessary and in accordance with
  121  state and federal law. Optional services rendered by providers
  122  in mobile units to Medicaid recipients may be restricted or
  123  prohibited by the agency. Nothing in this section shall be
  124  construed to prevent or limit the agency from adjusting fees,
  125  reimbursement rates, lengths of stay, number of visits, or
  126  number of services, or making any other adjustments necessary to
  127  comply with the availability of moneys and any limitations or
  128  directions provided for in the General Appropriations Act or
  129  chapter 216. If necessary to safeguard the state’s systems of
  130  providing services to elderly and disabled persons and subject
  131  to the notice and review provisions of s. 216.177, the Governor
  132  may direct the Agency for Health Care Administration to amend
  133  the Medicaid state plan to delete the optional Medicaid service
  134  known as “Intermediate Care Facilities for the Developmentally
  135  Disabled.” Optional services may include:
  136         (1) ADULT DENTAL SERVICES.—
  137         (c) However, Medicaid will not provide reimbursement for
  138  dental services provided in a mobile dental unit, except for a
  139  mobile dental unit:
  140         1. Owned by, operated by, or having a contractual agreement
  141  with the Department of Health and complying with Medicaid’s
  142  county health department clinic services program specifications
  143  as a county health department clinic services provider.
  144         2. Owned by, operated by, or having a contractual
  145  arrangement with a federally qualified health center and
  146  complying with Medicaid’s federally qualified health center
  147  specifications as a federally qualified health center provider.
  148         3. Rendering dental services to Medicaid recipients, 21
  149  years of age and older, at nursing facilities.
  150         4. Owned by, operated by, or having a contractual agreement
  151  with a state-approved dental educational institution.
  152         5. Owned by, operated by, or having a contract with a
  153  health access setting, as defined in s. 466.003, or another
  154  similar setting or program serving underserved or vulnerable
  155  populations facing serious barriers to access dental services,
  156  including, but not limited to: Early Head Start programs,
  157  homeless shelters, schools, and the Special Supplemental
  158  Nutrition Program for Women, Infants, and Children.
  159         Section 2. Section 466.001, Florida Statutes, is amended to
  160  read:
  161         466.001 Legislative purpose and intent.—The legislative
  162  purpose for enacting this chapter is to ensure that every
  163  dentist, dental therapist, or dental hygienist practicing in
  164  this state meets minimum requirements for safe practice without
  165  undue clinical interference by persons not licensed under this
  166  chapter. It is the legislative intent that dental services be
  167  provided only in accordance with the provisions of this chapter
  168  and not be delegated to unauthorized individuals. It is the
  169  further legislative intent that dentists, dental therapists, and
  170  dental hygienists who fall below minimum competency or who
  171  otherwise present a danger to the public shall be prohibited
  172  from practicing in this state. All provisions of this chapter
  173  relating to the practice of dentistry, dental therapy, and
  174  dental hygiene shall be liberally construed to carry out such
  175  purpose and intent.
  176         Section 3. Subsections (5) and (6) of section 466.002,
  177  Florida Statutes, are amended to read:
  178         466.002 Persons exempt from operation of chapter.—Nothing
  179  in this chapter shall apply to the following practices, acts,
  180  and operations:
  181         (5) Students in Florida schools of dentistry, dental
  182  therapy, and dental hygiene or dental assistant educational
  183  programs, while performing regularly assigned work under the
  184  curriculum of such schools.
  185         (6) Instructors in Florida schools of dentistry,
  186  instructors in dental programs that prepare persons holding
  187  D.D.S. or D.M.D. degrees for certification by a specialty board
  188  and that are accredited in the United States by January 1, 2005,
  189  in the same manner as the board recognizes accreditation for
  190  Florida schools of dentistry that are not otherwise affiliated
  191  with a Florida school of dentistry, or instructors in Florida
  192  schools of dental hygiene, dental therapy, or dental assistant
  193  educational programs, while performing regularly assigned
  194  instructional duties under the curriculum of such schools. A
  195  full-time dental instructor at a dental school or dental program
  196  approved by the board may be allowed to practice dentistry at
  197  the teaching facilities of such school or program, upon
  198  receiving a teaching permit issued by the board, in strict
  199  compliance with such rules as are adopted by the board
  200  pertaining to the teaching permit and with the established rules
  201  and procedures of the dental school or program as recognized in
  202  this section.
  203         Section 4.  Subsections (4) through (15) of section
  204  466.003, Florida Statutes are redesignated as subsections (6)
  205  through (17), respectively, present subsection (14) of that
  206  section is amended, and new subsections (4) and (5) are added to
  207  that section, to read:
  208         466.003 Definitions.—As used in this chapter:
  209         (4)“Dental therapist” means a person licensed to practice
  210  dental therapy pursuant to s. 466.0225.
  211         (5)“Dental therapy” means the rendering of services
  212  pursuant to s. 466.0227 and any related extraoral service or
  213  procedure required in the performance of such services.
  214         (16)(14) “Health access setting” means a program or an
  215  institution of the Department of Children and Families, the
  216  Department of Health, the Department of Juvenile Justice, a
  217  nonprofit community health center, a Head Start center, a
  218  federally qualified health center or look-alike as defined by
  219  federal law, a school-based prevention program, a clinic
  220  operated by an accredited college of dentistry, or an accredited
  221  dental hygiene or dental therapy program in this state if such
  222  community service program or institution immediately reports to
  223  the Board of Dentistry all violations of s. 466.027, s. 466.028,
  224  or other practice act or standard of care violations related to
  225  the actions or inactions of a dentist, dental hygienist, dental
  226  therapist, or dental assistant engaged in the delivery of dental
  227  care in such setting.
  228         Section 5. Subsection (2) of section 466.004, Florida
  229  Statutes, is amended to read:
  230         466.004 Board of Dentistry.—
  231         (2) To advise the board, it is the intent of the
  232  Legislature that councils be appointed as specified in
  233  paragraphs (a)-(d) (a), (b), and (c). The department shall
  234  provide administrative support to the councils and shall provide
  235  public notice of meetings and agenda of the councils. Councils
  236  shall include at least one board member who shall chair the
  237  council and shall include nonboard members. All council members
  238  shall be appointed by the board chair. Council members shall be
  239  appointed for 4-year terms, and all members shall be eligible
  240  for reimbursement of expenses in the manner of board members.
  241         (a) A Council on Dental Hygiene shall be appointed by the
  242  board chair and shall include one dental hygienist member of the
  243  board, who shall chair the council, one dental member of the
  244  board, and three dental hygienists who are actively engaged in
  245  the practice of dental hygiene in this state. In making the
  246  appointments, the chair shall consider recommendations from the
  247  Florida Dental Hygiene Association. The council shall meet at
  248  the request of the board chair, a majority of the members of the
  249  board, or the council chair; however, the council must meet at
  250  least three times a year. The council is charged with the
  251  responsibility of and shall meet for the purpose of developing
  252  rules and policies for recommendation to the board, which the
  253  board shall consider, on matters pertaining to that part of
  254  dentistry consisting of educational, preventive, or therapeutic
  255  dental hygiene services; dental hygiene licensure, discipline,
  256  or regulation; and dental hygiene education. Rule and policy
  257  recommendations of the council shall be considered by the board
  258  at its next regularly scheduled meeting in the same manner in
  259  which it considers rule and policy recommendations from
  260  designated subcommittees of the board. Any rule or policy
  261  proposed by the board pertaining to the specified part of
  262  dentistry defined by this subsection shall be referred to the
  263  council for a recommendation before final action by the board.
  264  The board may take final action on rules pertaining to the
  265  specified part of dentistry defined by this subsection without a
  266  council recommendation if the council fails to submit a
  267  recommendation in a timely fashion as prescribed by the board.
  268         (b) A Council on Dental Assisting shall be appointed by the
  269  board chair and shall include one board member who shall chair
  270  the council and three dental assistants who are actively engaged
  271  in dental assisting. The council shall meet at the request of
  272  the board chair or a majority of the members of the board. The
  273  council shall meet for the purpose of developing recommendations
  274  to the board on matters pertaining to that part of dentistry
  275  related to dental assisting.
  276         (c)A Council on Dental Therapy shall be appointed by the
  277  board chair and shall include one board member who shall chair
  278  the council and three dental therapists who are actively engaged
  279  in dental therapy. The council shall meet at the request of the
  280  board chair or a majority of the members of the board. The
  281  council shall meet for the purpose of developing recommendations
  282  to the board on matters pertaining to that part of dentistry
  283  related to dental therapy.
  284         (d)(c) With the concurrence of the State Surgeon General,
  285  the board chair may create and abolish other advisory councils
  286  relating to dental subjects, including, but not limited to:
  287  examinations, access to dental care, indigent care, nursing home
  288  and institutional care, public health, disciplinary guidelines,
  289  and other subjects as appropriate. Such councils shall be
  290  appointed by the board chair and shall include at least one
  291  board member who shall serve as chair.
  292         Section 6. Subsection (4) and paragraph (b) of subsection
  293  (6) of section 466.006, Florida Statutes, are amended to read:
  294         466.006 Examination of dentists.—
  295         (4) Notwithstanding any other provision of law in chapter
  296  456 pertaining to the clinical dental licensure examination or
  297  national examinations, to be licensed as a dentist in this
  298  state, an applicant must successfully complete the following:
  299         (a) A written examination on the laws and rules of the
  300  state regulating the practice of dentistry;
  301         (b)1. A practical or clinical examination, which shall be
  302  the American Dental Licensing Examination produced by the
  303  American Board of Dental Examiners, Inc., or its successor
  304  entity, if any, that is administered in this state and graded by
  305  dentists licensed in this state and employed by the department
  306  for just such purpose, provided that the board has attained, and
  307  continues to maintain thereafter, representation on the board of
  308  directors of the American Board of Dental Examiners, the
  309  examination development committee of the American Board of
  310  Dental Examiners, and such other committees of the American
  311  Board of Dental Examiners as the board deems appropriate by rule
  312  to assure that the standards established herein are maintained
  313  organizationally. A passing score on the American Dental
  314  Licensing Examination administered in this state and graded by
  315  dentists who are licensed in this state is valid for 365 days
  316  after the date the official examination results are published.
  317         2.a. As an alternative to the requirements of subparagraph
  318  1., an applicant may submit scores from an American Dental
  319  Licensing Examination previously administered in a jurisdiction
  320  other than this state after October 1, 2011, and such
  321  examination results shall be recognized as valid for the purpose
  322  of licensure in this state. A passing score on the American
  323  Dental Licensing Examination administered out-of-state shall be
  324  the same as the passing score for the American Dental Licensing
  325  Examination administered in this state and graded by dentists
  326  who are licensed in this state. The examination results are
  327  valid for 365 days after the date the official examination
  328  results are published. The applicant must have completed the
  329  examination after October 1, 2011.
  330         b. This subparagraph may not be given retroactive
  331  application.
  332         3. If the date of an applicant’s passing American Dental
  333  Licensing Examination scores from an examination previously
  334  administered in a jurisdiction other than this state under
  335  subparagraph 2. is older than 365 days, then such scores shall
  336  nevertheless be recognized as valid for the purpose of licensure
  337  in this state, but only if the applicant demonstrates that all
  338  of the following additional standards have been met:
  339         a.(I) The applicant completed the American Dental Licensing
  340  Examination after October 1, 2011.
  341         (II) This sub-subparagraph may not be given retroactive
  342  application;
  343         b. The applicant graduated from a dental school accredited
  344  by the American Dental Association Commission on Dental
  345  Accreditation or its successor entity, if any, or any other
  346  dental accrediting organization recognized by the United States
  347  Department of Education. Provided, however, if the applicant did
  348  not graduate from such a dental school, the applicant may submit
  349  proof of having successfully completed a full-time supplemental
  350  general dentistry program accredited by the American Dental
  351  Association Commission on Dental Accreditation of at least 2
  352  consecutive academic years at such accredited sponsoring
  353  institution. Such program must provide didactic and clinical
  354  education at the level of a D.D.S. or D.M.D. program accredited
  355  by the American Dental Association Commission on Dental
  356  Accreditation;
  357         c. The applicant currently possesses a valid and active
  358  dental license in good standing, with no restriction, which has
  359  never been revoked, suspended, restricted, or otherwise
  360  disciplined, from another state or territory of the United
  361  States, the District of Columbia, or the Commonwealth of Puerto
  362  Rico;
  363         d. The applicant submits proof that he or she has never
  364  been reported to the National Practitioner Data Bank, the
  365  Healthcare Integrity and Protection Data Bank, or the American
  366  Association of Dental Boards Clearinghouse. This sub
  367  subparagraph does not apply if the applicant successfully
  368  appealed to have his or her name removed from the data banks of
  369  these agencies;
  370         e.(I) In the 5 years immediately preceding the date of
  371  application for licensure in this state, the applicant must
  372  submit proof of having been consecutively engaged in the full
  373  time practice of dentistry in another state or territory of the
  374  United States, the District of Columbia, or the Commonwealth of
  375  Puerto Rico, or, if the applicant has been licensed in another
  376  state or territory of the United States, the District of
  377  Columbia, or the Commonwealth of Puerto Rico for less than 5
  378  years, the applicant must submit proof of having been engaged in
  379  the full-time practice of dentistry since the date of his or her
  380  initial licensure.
  381         (II) As used in this section, “full-time practice” is
  382  defined as a minimum of 1,200 hours per year for each and every
  383  year in the consecutive 5-year period or, where applicable, the
  384  period since initial licensure, and must include any combination
  385  of the following:
  386         (A) Active clinical practice of dentistry providing direct
  387  patient care.
  388         (B) Full-time practice as a faculty member employed by a
  389  dental, dental therapy, or dental hygiene school approved by the
  390  board or accredited by the American Dental Association
  391  Commission on Dental Accreditation.
  392         (C) Full-time practice as a student at a postgraduate
  393  dental education program approved by the board or accredited by
  394  the American Dental Association Commission on Dental
  395  Accreditation.
  396         (III) The board shall develop rules to determine what type
  397  of proof of full-time practice is required and to recoup the
  398  cost to the board of verifying full-time practice under this
  399  section. Such proof must, at a minimum, be:
  400         (A) Admissible as evidence in an administrative proceeding;
  401         (B) Submitted in writing;
  402         (C) Submitted by the applicant under oath with penalties of
  403  perjury attached;
  404         (D) Further documented by an affidavit of someone unrelated
  405  to the applicant who is familiar with the applicant’s practice
  406  and testifies with particularity that the applicant has been
  407  engaged in full-time practice; and
  408         (E) Specifically found by the board to be both credible and
  409  admissible.
  410         (IV) An affidavit of only the applicant is not acceptable
  411  proof of full-time practice unless it is further attested to by
  412  someone unrelated to the applicant who has personal knowledge of
  413  the applicant’s practice. If the board deems it necessary to
  414  assess credibility or accuracy, the board may require the
  415  applicant or the applicant’s witnesses to appear before the
  416  board and give oral testimony under oath;
  417         f. The applicant must submit documentation that he or she
  418  has completed, or will complete, prior to licensure in this
  419  state, continuing education equivalent to this state’s
  420  requirements for the last full reporting biennium;
  421         g. The applicant must prove that he or she has never been
  422  convicted of, or pled nolo contendere to, regardless of
  423  adjudication, any felony or misdemeanor related to the practice
  424  of a health care profession in any jurisdiction;
  425         h. The applicant must successfully pass a written
  426  examination on the laws and rules of this state regulating the
  427  practice of dentistry and must successfully pass the computer
  428  based diagnostic skills examination; and
  429         i. The applicant must submit documentation that he or she
  430  has successfully completed the National Board of Dental
  431  Examiners dental examination.
  432         (6)
  433         (b)1. As used in this section, “full-time practice of
  434  dentistry within the geographic boundaries of this state within
  435  1 year” is defined as a minimum of 1,200 hours in the initial
  436  year of licensure, which must include any combination of the
  437  following:
  438         a. Active clinical practice of dentistry providing direct
  439  patient care within the geographic boundaries of this state.
  440         b. Full-time practice as a faculty member employed by a
  441  dental, dental therapy, or dental hygiene school approved by the
  442  board or accredited by the American Dental Association
  443  Commission on Dental Accreditation and located within the
  444  geographic boundaries of this state.
  445         c. Full-time practice as a student at a postgraduate dental
  446  education program approved by the board or accredited by the
  447  American Dental Association Commission on Dental Accreditation
  448  and located within the geographic boundaries of this state.
  449         2. The board shall develop rules to determine what type of
  450  proof of full-time practice of dentistry within the geographic
  451  boundaries of this state for 1 year is required in order to
  452  maintain active licensure and shall develop rules to recoup the
  453  cost to the board of verifying maintenance of such full-time
  454  practice under this section. Such proof must, at a minimum:
  455         a. Be admissible as evidence in an administrative
  456  proceeding;
  457         b. Be submitted in writing;
  458         c. Be submitted by the applicant under oath with penalties
  459  of perjury attached;
  460         d. Be further documented by an affidavit of someone
  461  unrelated to the applicant who is familiar with the applicant’s
  462  practice and testifies with particularity that the applicant has
  463  been engaged in full-time practice of dentistry within the
  464  geographic boundaries of this state within the last 365 days;
  465  and
  466         e. Include such additional proof as specifically found by
  467  the board to be both credible and admissible.
  468         3. An affidavit of only the applicant is not acceptable
  469  proof of full-time practice of dentistry within the geographic
  470  boundaries of this state within 1 year, unless it is further
  471  attested to by someone unrelated to the applicant who has
  472  personal knowledge of the applicant’s practice within the last
  473  365 days. If the board deems it necessary to assess credibility
  474  or accuracy, the board may require the applicant or the
  475  applicant’s witnesses to appear before the board and give oral
  476  testimony under oath.
  477         Section 7. Section 466.0075, Florida Statutes, is amended
  478  to read:
  479         466.0075 Applicants for examination; medical malpractice
  480  insurance.—The board may require any person applying to take the
  481  examination to practice dentistry in this state, the examination
  482  to practice dental therapy in this state, or the examination to
  483  practice dental hygiene in this state to maintain medical
  484  malpractice insurance in amounts sufficient to cover any
  485  incident of harm to a patient during the clinical examination.
  486         Section 8. Subsection (1) of section 466.009, Florida
  487  Statutes, is amended, and subsection (4) is added to that
  488  section, to read:
  489         466.009 Reexamination.—
  490         (1) The department shall allow permit any person who fails
  491  an examination that which is required under s. 466.006, or s.
  492  466.007, or s. 466.0225 to retake the examination. If the
  493  examination to be retaken is a practical or clinical
  494  examination, the applicant shall pay a reexamination fee set by
  495  rule of the board in an amount not to exceed the original
  496  examination fee.
  497         (4) If an applicant for a license to practice dental
  498  therapy fails the practical or clinical examination and has
  499  failed only one part or procedure of the examination, she or he
  500  may only be required to retake that part or procedure to pass
  501  the examination. However, if any such applicant fails more than
  502  one part or procedure of any such examination, she or he shall
  503  be required to retake the entire examination.
  504         Section 9. Section 466.011, Florida Statutes, is amended to
  505  read:
  506         466.011 Licensure.—The board shall certify for licensure by
  507  the department any applicant who satisfies the requirements of
  508  s. 466.006, s. 466.0067, or s. 466.007, or s. 466.0225. The
  509  board may refuse to certify an applicant who has violated any of
  510  the provisions of s. 466.026 or s. 466.028.
  511         Section 10. Section 466.0136, Florida Statutes, is created
  512  to read:
  513         466.0136 Continuing education; dental therapists.—In
  514  addition to the other requirements for relicensure for dental
  515  therapists set out in this chapter, the board shall require each
  516  licensed dental therapist to complete at least 24 hours but not
  517  more than 36 hours of continuing professional education in
  518  dental subjects, biennially, in programs prescribed or approved
  519  by the board or in equivalent programs of continuing education.
  520  Programs of continuing education approved by the board shall be
  521  programs of learning which, in the opinion of the board,
  522  contribute directly to the dental education of the dental
  523  therapist. The board shall adopt rules and guidelines to
  524  administer and enforce this section. The dental therapist shall
  525  retain in her or his records any receipts, vouchers, or
  526  certificates necessary to document completion of such continuing
  527  education. Compliance with the continuing education requirements
  528  is mandatory for issuance of the renewal certificate. The board
  529  may excuse licensees, as a group or as individuals, from all or
  530  part of the continuing education requirements if an unusual
  531  circumstance, emergency, or hardship has prevented compliance
  532  with this section.
  533         Section 11. Section 466.016, Florida Statutes, is amended
  534  to read:
  535         466.016 License to be displayed.—Every practitioner of
  536  dentistry, dental therapy, or dental hygiene within the meaning
  537  of this chapter shall post and keep conspicuously displayed her
  538  or his license in the office wherein she or he practices, in
  539  plain sight of the practitioner’s patients. Any dentist, dental
  540  therapist, or dental hygienist who practices at more than one
  541  location shall be required to display a copy of her or his
  542  license in each office where she or he practices.
  543         Section 12. Present subsections (7) and (8) of section
  544  466.017, Florida Statutes, are redesignated as subsections (8)
  545  and (9), respectively, a new subsection (7) is added to that
  546  section, and paragraphs (d) and (e) of subsection (3),
  547  subsection (4), and present subsections (7) and (8) of that
  548  section, are amended, to read:
  549         466.017 Prescription of drugs; anesthesia.—
  550         (3) The board shall adopt rules which:
  551         (d) Establish further requirements relating to the use of
  552  general anesthesia or sedation, including, but not limited to,
  553  office equipment and the training of dental assistants, dental
  554  therapists, or dental hygienists who work with dentists using
  555  general anesthesia or sedation.
  556         (e) Establish an administrative mechanism enabling the
  557  board to verify compliance with training, education, experience,
  558  equipment, or certification requirements of dentists, dental
  559  therapists, dental hygienists, and dental assistants adopted
  560  pursuant to this subsection. The board may charge a fee to
  561  defray the cost of verifying compliance with requirements
  562  adopted pursuant to this paragraph.
  563         (4) A dentist, dental therapist, or dental hygienist who
  564  administers or employs the use of any form of anesthesia must
  565  possess a certification in either basic cardiopulmonary
  566  resuscitation for health professionals or advanced cardiac life
  567  support approved by the American Heart Association or the
  568  American Red Cross or an equivalent agency-sponsored course with
  569  recertification every 2 years. Each dental office which uses any
  570  form of anesthesia must have immediately available and in good
  571  working order such resuscitative equipment, oxygen, and other
  572  resuscitative drugs as are specified by rule of the board in
  573  order to manage possible adverse reactions.
  574         (7) A dental therapist under general supervision of a
  575  dentist may administer local anesthesia, including intraoral
  576  block anesthesia or soft tissue infiltration anesthesia, or
  577  both, if she or he has completed the course described in
  578  paragraph (5)(a) and presents evidence of current certification
  579  in basic or advanced cardiac life support.
  580         (8)(7) A licensed dentist, or a dental therapist who is
  581  authorized by her or his supervising dentist, may utilize an X
  582  ray machine, expose dental X-ray films, and interpret or read
  583  such films. The provisions of part IV of chapter 468 to the
  584  contrary notwithstanding, a licensed dentist, or a dental
  585  therapist who is authorized by his or her supervising dentist,
  586  may authorize or direct a dental assistant to operate such
  587  equipment and expose such films under her or his direction and
  588  supervision, pursuant to rules adopted by the board in
  589  accordance with s. 466.024 which ensure that said assistant is
  590  competent by reason of training and experience to operate said
  591  equipment in a safe and efficient manner. The board may charge a
  592  fee not to exceed $35 to defray the cost of verifying compliance
  593  with requirements adopted pursuant to this section.
  594         (9)(8) The provisions of s. 465.0276 notwithstanding, a
  595  dentist need not register with the board or comply with the
  596  continuing education requirements of that section if the dentist
  597  confines her or his dispensing activity to the dispensing of
  598  fluorides and chlorhexidine chlorohexidine rinse solutions;
  599  provided that the dentist complies with and is subject to all
  600  laws and rules applicable to pharmacists and pharmacies,
  601  including, but not limited to, chapters 465, 499, and 893, and
  602  all applicable federal laws and regulations, when dispensing
  603  such products.
  604         Section 13. Subsection (1) of section 466.018, Florida
  605  Statutes, is amended to read:
  606         466.018 Dentist of record; patient records.—
  607         (1) Each patient shall have a dentist of record. The
  608  dentist of record shall remain primarily responsible for all
  609  dental treatment on such patient regardless of whether the
  610  treatment is rendered by the dentist or by another dentist,
  611  dental therapist, dental hygienist, or dental assistant
  612  rendering such treatment in conjunction with, at the direction
  613  or request of, or under the supervision of such dentist of
  614  record. The dentist of record shall be identified in the record
  615  of the patient. If treatment is rendered by a dentist other than
  616  the dentist of record or by a dental hygienist, dental
  617  therapist, or dental assistant, the name or initials of such
  618  person shall be placed in the record of the patient. In any
  619  disciplinary proceeding brought pursuant to this chapter or
  620  chapter 456, it shall be presumed as a matter of law that
  621  treatment was rendered by the dentist of record unless otherwise
  622  noted on the patient record pursuant to this section. The
  623  dentist of record and any other treating dentist are subject to
  624  discipline pursuant to this chapter or chapter 456 for treatment
  625  rendered the patient and performed in violation of such chapter.
  626  One of the purposes of this section is to ensure that the
  627  responsibility for each patient is assigned to one dentist in a
  628  multidentist practice of any nature and to assign primary
  629  responsibility to the dentist for treatment rendered by a dental
  630  hygienist or assistant under her or his supervision. This
  631  section shall not be construed to assign any responsibility to a
  632  dentist of record for treatment rendered pursuant to a proper
  633  referral to another dentist not in practice with the dentist of
  634  record or to prohibit a patient from voluntarily selecting a new
  635  dentist without permission of the dentist of record.
  636         Section 14. Section 466.0225, Florida Statutes, is created
  637  to read:
  638         466.0225Examination of dental therapists; licensing.—
  639         (1)Any person desiring to be licensed as a dental
  640  therapist must apply to the department to take the licensure
  641  examinations and shall verify the information required on the
  642  application by oath. The application shall include two recent
  643  photographs of the applicant. There shall be a nonrefundable
  644  application fee set by the board not to exceed $100 and an
  645  examination fee set by the board which shall not be more than
  646  $225. The examination fee may be refunded if the applicant is
  647  found ineligible to take the examinations.
  648         (2)An applicant is entitled to take the examinations
  649  required in this section and practice dental therapy in this
  650  state if the applicant:
  651         (a) Is 18 years of age or older;
  652         (b) Is a graduate of a dental therapy college or school
  653  accredited by the American Dental Association Commission on
  654  Dental Accreditation or its successor entity, if any, or any
  655  other dental therapy accrediting entity recognized by the United
  656  States Department of Education. For applicants applying for a
  657  dental therapy license before January 1, 2023, the board shall
  658  approve the applicant’s dental therapy education program if the
  659  program was administered by a college or school that operates an
  660  accredited dental or dental hygiene program and the college or
  661  school certifies to the board that the applicant’s education
  662  substantially conformed to the education standards established
  663  by the American Dental Association Commission on Dental
  664  Accreditation;
  665         (c) Has successfully completed a dental therapy practical
  666  or clinical examination produced by the American Board of Dental
  667  Examiners, Inc., (ADEX) or its successor entity, if any, if the
  668  board finds that the successor entity’s examination meets or
  669  exceeds the provisions of this section. If an applicant fails to
  670  pass the ADEX Dental Therapy Examination in three attempts, the
  671  applicant is not eligible to retake the examination unless the
  672  applicant completes additional education requirements as
  673  specified by the board. If a dental therapy examination has not
  674  been established by the ADEX, the board shall administer or
  675  approve an alternative examination;
  676         (d) Has not been disciplined by a board, except for
  677  citation offenses or minor violations;
  678         (e) Has not been convicted of or pled nolo contendere to,
  679  regardless of adjudication, any felony or misdemeanor related to
  680  the practice of a health care profession; and
  681         (f) Has successfully completed a written examination on the
  682  laws and rules of this state regulating the practice of dental
  683  therapy.
  684         (3) An applicant who meets the requirements of this
  685  section, who has successfully completed the examinations
  686  identified in paragraph (2)(c) in a jurisdiction other than this
  687  state, or who has successfully completed comparable examinations
  688  administered or approved by the licensing authority in that
  689  jurisdiction shall be licensed to practice dental therapy in
  690  this state if the board determines that the other jurisdiction’s
  691  examinations and scope of practice are substantially similar to
  692  those identified in paragraph (2)(c).
  693         Section 15. Section 466.0226, Florida Statutes, is created
  694  to read:
  695         466.0226Dental therapy; licensing for dental school
  696  graduates.—An applicant who satisfied the examination
  697  requirements in s. 466.0225 may take the examinations required
  698  in this section and shall be licensed to practice dental therapy
  699  in this state if the applicant is a graduate of a dental college
  700  or school accredited in accordance with s. 466.006(2)(b), or if
  701  the applicant is a graduate of an unaccredited dental college or
  702  school and has:
  703         (1)Successfully completed the National Board Dental
  704  Examination for dentistry or dental therapy or an alternative
  705  examination approved by the board under this section;
  706         (2) Submitted for review by the board transcripts totaling
  707  4 academic years of postsecondary dental education and a dental
  708  school diploma that is comparable to a D.D.S. or D.M.D.
  709         (a) Such credentials shall be submitted in a manner
  710  provided by rule of the board. The board shall approve those
  711  credentials that comply with this subsection and with rules of
  712  the board adopted pursuant to this subsection.
  713         (b) An applicant who graduated from a foreign dental
  714  college or a school not accredited in accordance with s.
  715  466.006(2)(b) and who cannot produce the credentials required by
  716  this subsection, as a result of political or other conditions in
  717  the country in which the applicant received his or her
  718  education, may seek the board’s approval of his or her
  719  educational background by submitting, in lieu of the credentials
  720  required in this subsection, such other reasonable and reliable
  721  evidence as may be set forth by board rule. The board shall not
  722  accept such other evidence until it has made a reasonable
  723  attempt to obtain the credentials required by this subsection
  724  from the educational institutions the applicant is alleged to
  725  have attended, unless the board is otherwise satisfied that such
  726  credentials cannot be obtained.
  727         (3) Successfully completed one or more courses, of a scope
  728  and duration approved and defined by board rule, which meet the
  729  requirements of law for instructing health care providers on the
  730  human immunodeficiency virus and acquired immune deficiency
  731  syndrome. In addition, the board may require an applicant who
  732  graduated from a nonaccredited dental college or school to
  733  successfully complete additional coursework, only after failing
  734  the initial examination, as defined by board rule, at an
  735  educational institution approved by the board or accredited as
  736  provided in s. 466.006(2)(b). A graduate of a foreign dental
  737  college or school that is not accredited in accordance with s.
  738  466.006(2)(b) may not take the examinations required in this
  739  section until the board has approved the credentials required by
  740  subsection (2).
  741         Section 16. Section 466.0227, Florida Statutes, is created
  742  to read:
  743         466.0227Dental therapists; scope and area of practice.—
  744         (1) Except as otherwise provided in this chapter, a dental
  745  therapist may perform the dental therapy services specified in
  746  subsection (2) under the general supervision of a dentist to the
  747  extent authorized by the supervising dentist and provided within
  748  the terms of a written collaborative management agreement signed
  749  by the dental therapist and the supervising dentist which meets
  750  the requirements of subsection (3).
  751         (2) Dental therapy services include all of the following:
  752         (a) All services, treatments, and competencies identified
  753  by the American Dental Association Commission on Dental
  754  Accreditation in its dental therapy education accreditation
  755  standards; and
  756         (b) The following state-specific services, if the dental
  757  therapist’s education included curriculum content satisfying the
  758  American Dental Association Commission on Dental Accreditation
  759  criteria for state-specific dental therapy services:
  760         1. Evaluating radiographs.
  761         2. Placement of space maintainers.
  762         3. Pulpotomies on primary teeth.
  763         4. Nonsurgical extractions of periodontally diseased
  764  permanent teeth with tooth mobility of +3 to +4 under general
  765  supervision if authorized in advance by the collaborating
  766  dentist. A dental therapist may not extract a tooth that is
  767  unerupted, impacted, or fractured or needs to be sectioned for
  768  removal.
  769         5. Dispensing and administering analgesics including
  770  nitrous oxide, antiinflammatories, and antibiotics as authorized
  771  by the supervising dentist and within the parameters of the
  772  collaborative management agreement.
  773         6. Oral evaluation and assessment of dental disease and
  774  formulation of an individualized treatment plan if authorized by
  775  a supervising dentist and subject to any conditions,
  776  limitations, and protocols specified by the supervising dentist
  777  in the collaborative management agreement.
  778         (3) Before performing any of the services authorized under
  779  this chapter, a dental therapist must enter into a written
  780  collaborative management agreement with a supervising dentist.
  781  The agreement must be signed by the dental therapist and the
  782  supervising dentist and include:
  783         (a) Practice settings where services may be provided and
  784  the populations to be served;
  785         (b) Any limitations on the services that may be provided by
  786  the dental therapist, including the level of supervision
  787  required by the collaborating dentist;
  788         (c) Age and procedure-specific practice protocols,
  789  including case selection criteria, assessment guidelines, and
  790  imaging frequency;
  791         (d) A procedure for creating and maintaining dental records
  792  for the patients that are treated by the dental therapist;
  793         (e) A plan to manage medical emergencies in each practice
  794  setting where the dental therapist provides care;
  795         (f) A quality assurance plan for monitoring care provided
  796  by the dental therapist, including patient care review, referral
  797  followup, and a quality assurance chart review;
  798         (g) Protocols for administering and dispensing medications,
  799  including the specific conditions and circumstance under which
  800  these medications are to be dispensed and administered;
  801         (h) Criteria relating to the provision of care to patients
  802  with specific medical conditions or complex medication
  803  histories, including requirements for consultation before the
  804  initiation of care;
  805         (i) Supervision criteria of dental assistants; and
  806         (j) A plan for the provision of clinical resources and
  807  referrals in situations that are beyond the capabilities of the
  808  dental therapist.
  809         (4) The supervising dentist may restrict or limit the
  810  dental therapist’s practice in a collaborative management
  811  agreement to be less than the full scope of practice for dental
  812  therapists which is authorized in subsection (2).
  813         (5) A supervising dentist may authorize a dental therapist
  814  to provide dental therapy services to a patient before the
  815  dentist examines or diagnoses the patient, if the authority,
  816  conditions, and protocols are established in a written
  817  collaborative management agreement and if the patient is
  818  subsequently referred to a dentist for any needed additional
  819  services that exceed the dental therapist’s scope of practice or
  820  authorization under the collaborative management agreement.
  821         (6) A supervising dentist must be licensed and practicing
  822  in this state. The supervising dentist is responsible for all
  823  services authorized and performed by the dental therapist
  824  pursuant to the collaborative management agreement and for
  825  providing or arranging followup services to be provided by a
  826  dentist for those services that are beyond the dental
  827  therapist’s scope of practice and authorization under the
  828  collaborative management agreement.
  829         Section 17. Section 466.026, Florida Statutes, is amended
  830  to read:
  831         466.026 Prohibitions; penalties.—
  832         (1) Each of the following acts constitutes a felony of the
  833  third degree, punishable as provided in s. 775.082, s. 775.083,
  834  or s. 775.084:
  835         (a) Practicing dentistry, dental therapy, or dental hygiene
  836  unless the person has an appropriate, active license issued by
  837  the department pursuant to this chapter.
  838         (b) Using or attempting to use a license issued pursuant to
  839  this chapter which license has been suspended or revoked.
  840         (c) Knowingly employing any person to perform duties
  841  outside the scope allowed such person under this chapter or the
  842  rules of the board.
  843         (d) Giving false or forged evidence to the department or
  844  board for the purpose of obtaining a license.
  845         (e) Selling or offering to sell a diploma conferring a
  846  degree from a dental college or dental hygiene or dental therapy
  847  school or college, or a license issued pursuant to this chapter,
  848  or procuring such diploma or license with intent that it shall
  849  be used as evidence of that which the document stands for, by a
  850  person other than the one upon whom it was conferred or to whom
  851  it was granted.
  852         (2) Each of the following acts constitutes a misdemeanor of
  853  the first degree, punishable as provided in s. 775.082 or s.
  854  775.083:
  855         (a) Using the name or title “dentist,” the letters “D.D.S.”
  856  or “D.M.D.”, or any other words, letters, title, or descriptive
  857  matter which in any way represents a person as being able to
  858  diagnose, treat, prescribe, or operate for any disease, pain,
  859  deformity, deficiency, injury, or physical condition of the
  860  teeth or jaws or oral-maxillofacial region unless the person has
  861  an active dentist’s license issued by the department pursuant to
  862  this chapter.
  863         (b) Using the name “dental hygienist” or the initials
  864  “R.D.H.” or otherwise holding herself or himself out as an
  865  actively licensed dental hygienist or implying to any patient or
  866  consumer that she or he is an actively licensed dental hygienist
  867  unless that person has an active dental hygienist’s license
  868  issued by the department pursuant to this chapter.
  869         (c) Using the name “dental therapist” or the initials
  870  “D.T.” or otherwise holding herself or himself out as an
  871  actively licensed dental therapist or implying to any patient or
  872  consumer that she or he is an actively licensed dental therapist
  873  unless that person has an active dental therapist’s license
  874  issued by the department pursuant to this chapter.
  875         (d)(c) Presenting as her or his own the license of another.
  876         (e)(d) Knowingly concealing information relative to
  877  violations of this chapter.
  878         (f)(e) Performing any services as a dental assistant as
  879  defined herein, except in the office of a licensed dentist,
  880  unless authorized by this chapter or by rule of the board.
  881         Section 18. Paragraphs (b), (c), (g), (s), and (t) of
  882  subsection (1) of section 466.028, Florida Statutes, are amended
  883  to read:
  884         466.028 Grounds for disciplinary action; action by the
  885  board.—
  886         (1) The following acts constitute grounds for denial of a
  887  license or disciplinary action, as specified in s. 456.072(2):
  888         (b) Having a license to practice dentistry, dental therapy,
  889  or dental hygiene revoked, suspended, or otherwise acted
  890  against, including the denial of licensure, by the licensing
  891  authority of another state, territory, or country.
  892         (c) Being convicted or found guilty of or entering a plea
  893  of nolo contendere to, regardless of adjudication, a crime in
  894  any jurisdiction which relates to the practice of dentistry,
  895  dental therapy, or dental hygiene. A plea of nolo contendere
  896  shall create a rebuttable presumption of guilt to the underlying
  897  criminal charges.
  898         (g) Aiding, assisting, procuring, or advising any
  899  unlicensed person to practice dentistry, dental therapy, or
  900  dental hygiene contrary to this chapter or to a rule of the
  901  department or the board.
  902         (s) Being unable to practice her or his profession with
  903  reasonable skill and safety to patients by reason of illness or
  904  use of alcohol, drugs, narcotics, chemicals, or any other type
  905  of material or as a result of any mental or physical condition.
  906  In enforcing this paragraph, the department shall have, upon a
  907  finding of the State Surgeon General or her or his designee that
  908  probable cause exists to believe that the licensee is unable to
  909  practice dentistry, dental therapy, or dental hygiene because of
  910  the reasons stated in this paragraph, the authority to issue an
  911  order to compel a licensee to submit to a mental or physical
  912  examination by physicians designated by the department. If the
  913  licensee refuses to comply with such order, the department’s
  914  order directing such examination may be enforced by filing a
  915  petition for enforcement in the circuit court where the licensee
  916  resides or does business. The licensee against whom the petition
  917  is filed shall not be named or identified by initials in any
  918  public court records or documents, and the proceedings shall be
  919  closed to the public. The department shall be entitled to the
  920  summary procedure provided in s. 51.011. A licensee affected
  921  under this paragraph shall at reasonable intervals be afforded
  922  an opportunity to demonstrate that she or he can resume the
  923  competent practice of her or his profession with reasonable
  924  skill and safety to patients.
  925         (t) Fraud, deceit, or misconduct in the practice of
  926  dentistry, dental therapy, or dental hygiene.
  927         Section 19. Paragraphs (a) and (b) of subsection (1) of
  928  section 466.0285, Florida Statutes, are amended to read:
  929         466.0285 Proprietorship by nondentists.—
  930         (1) No person other than a dentist licensed pursuant to
  931  this chapter, nor any entity other than a professional
  932  corporation or limited liability company composed of dentists,
  933  may:
  934         (a) Employ a dentist, dental therapist, or dental hygienist
  935  in the operation of a dental office.
  936         (b) Control the use of any dental equipment or material
  937  while such equipment or material is being used for the provision
  938  of dental services, whether those services are provided by a
  939  dentist, a dental therapist, a dental hygienist, or a dental
  940  assistant.
  941  
  942  Any lease agreement, rental agreement, or other arrangement
  943  between a nondentist and a dentist whereby the nondentist
  944  provides the dentist with dental equipment or dental materials
  945  shall contain a provision whereby the dentist expressly
  946  maintains complete care, custody, and control of the equipment
  947  or practice.
  948         Section 20. Subsection (1) of section 466.051, Florida
  949  Statutes, is amended to read:
  950         466.051 Confidentiality of certain information contained in
  951  dental workforce surveys.—
  952         (1) Personal identifying information that is contained in a
  953  record provided by a dentist, dental therapist, or dental
  954  hygienist licensed under this chapter in response to a dental
  955  workforce survey and held by the Department of Health is
  956  confidential and exempt from s. 119.07(1) and s. 24(a), Art. I
  957  of the State Constitution. Personal identifying information in
  958  such a record:
  959         (a) Shall be disclosed with the express written consent of
  960  the individual to whom the information pertains or the
  961  individual’s legally authorized representative.
  962         (b) Shall be disclosed by court order upon a showing of
  963  good cause.
  964         (c) May be disclosed to a research entity, if the entity
  965  seeks the records or data pursuant to a research protocol
  966  approved by the Department of Health, maintains the records or
  967  data in accordance with the approved protocol, and enters into a
  968  purchase and data-use agreement with the department, the fee
  969  provisions of which are consistent with s. 119.07(4). The
  970  department may deny a request for records or data if the
  971  protocol provides for intrusive follow-back contacts, does not
  972  plan for the destruction of the confidential records after the
  973  research is concluded, is administratively burdensome, or does
  974  not have scientific merit. The agreement must prohibit the
  975  release of information by the research entity which would
  976  identify individuals, limit the use of records or data to the
  977  approved research protocol, and prohibit any other use of the
  978  records or data. Copies of records or data issued pursuant to
  979  this paragraph remain the property of the department.
  980         Section 21. The Department of Health, in consultation with
  981  the Board of Dentistry and the Agency for Health Care
  982  Administration, shall submit a progress report to the President
  983  of the Senate and Speaker of the House of Representatives by
  984  July 1, 2021, and a final report 3 years after the first dental
  985  therapy license is issued. The report must include all of the
  986  following components:
  987         (1) The progress that has been made in this state to
  988  implement dental therapy training programs, licensing, and
  989  Medicaid reimbursement;
  990         (2) Data demonstrating the effects of dental therapy in
  991  this state on:
  992         (a) Access to dental services;
  993         (b) The use of primary and preventive dental services in
  994  underserved regions and populations, including the Medicaid
  995  population;
  996         (c) Costs to dental providers, patients, dental insurance
  997  carriers, and the state; and
  998         (d) The quality and safety of dental services;
  999         (3)Specific recommendations for any necessary legislative,
 1000  administrative, or regulatory reform relating to the practice of
 1001  dental therapy; and
 1002         (4) Any other information deemed appropriate by the
 1003  department.
 1004         Section 22. This act shall take effect July 1, 2018.