Florida Senate - 2023                                     SB 356
       By Senator Boyd
       20-00350A-23                                           2023356__
    1                        A bill to be entitled                      
    2         An act relating to the practice of dentistry; amending
    3         s. 466.003, F.S.; defining the term “digital
    4         scanning”; amending s. 466.016, F.S.; requiring
    5         dentists to provide each patient with specified
    6         information; requiring individuals and entities that
    7         provide dental services through telehealth to provide
    8         each patient with specified information regarding the
    9         dentists treating such patient; amending s. 466.018,
   10         F.S.; requiring that there be a dentist of record for
   11         each patient treated through telehealth; subjecting
   12         such dentists to certain requirements; requiring
   13         individuals and entities that provide dental services
   14         through telehealth to make specified information
   15         available to each patient before rendering such
   16         services and at any time upon patient request;
   17         providing construction; amending s. 466.019, F.S.;
   18         defining the term “advertisement”; requiring that
   19         advertisements of specified dental services provided
   20         through telehealth contain a specified disclaimer;
   21         amending s. 466.024, F.S.; specifying that only
   22         certain dental practitioners may perform specified
   23         functions of dentistry; amending s. 466.028, F.S.;
   24         providing additional grounds for disciplinary action
   25         against dental practitioners; amending s. 409.906,
   26         F.S.; conforming a cross-reference; providing an
   27         effective date.
   29  Be It Enacted by the Legislature of the State of Florida:
   31         Section 1. Present subsections (8) through (15) of section
   32  466.003, Florida Statutes, are redesignated as subsections (9)
   33  through (16), respectively, a new subsection (8) is added to
   34  that section, and present subsection (15) of that section is
   35  amended, to read:
   36         466.003 Definitions.—As used in this chapter:
   37         (8) “Digital scanning” means the use of digital technology
   38  that creates a computer-generated replica of the hard and soft
   39  tissue of the oral cavity using enhanced digital photography,
   40  lasers, or other optical scanning devices.
   41         (16)(15) “School-based prevention program” means preventive
   42  oral health services offered at a school by one of the entities
   43  defined in subsection (15) (14) or by a nonprofit organization
   44  that is exempt from federal income taxation under s. 501(a) of
   45  the Internal Revenue Code, and described in s. 501(c)(3) of the
   46  Internal Revenue Code.
   47         Section 2. Section 466.016, Florida Statutes, is amended to
   48  read:
   49         466.016 License to be displayed.—
   50         (1) Every practitioner of dentistry or dental hygiene
   51  within the meaning of this chapter shall post and keep
   52  conspicuously displayed her or his license in the office wherein
   53  she or he practices, in plain sight of the practitioner’s
   54  patients. Any dentist or dental hygienist who practices at more
   55  than one location must shall be required to display a copy of
   56  her or his license in each office where she or he practices.
   57         (2)Every dentist shall provide each of her or his patients
   58  with the dentist’s name, contact telephone number, after-hours
   59  contact information for emergencies, and, upon the patient’s
   60  request, license information.
   61         (3)Any individual, partnership, corporation, or other
   62  entity that provides dental services through telehealth as
   63  defined in s. 456.47 shall provide each patient with the name,
   64  contact telephone number, after-hours contact information for
   65  emergencies, and, upon the patient’s request, license
   66  information of each dentist who provides dental services to the
   67  patient through telehealth.
   68         Section 3. Subsection (6) is added to section 466.018,
   69  Florida Statutes, to read:
   70         466.018 Dentist of record; patient records.—
   71         (6) For any patient treated through telehealth as defined
   72  in s. 456.47, there must be a dentist of record who remains
   73  primarily responsible for all dental treatment on the patient
   74  regardless of whether the treatment is rendered by the dentist
   75  of record or by another dentist, dental hygienist, or dental
   76  assistant rendering such treatment in conjunction with, at the
   77  direction or request of, or under the supervision of such
   78  dentist of record. A dentist of record for a patient treated
   79  through telehealth is subject to all of the requirements of this
   80  section applicable to dentists of record.
   81         (a)Any individual, partnership, corporation, or other
   82  entity that provides dental services through telehealth shall
   83  make available the name, telephone number, practice address, and
   84  state license number for the dentist of record and any other
   85  dentist who will be involved in the provision of services to a
   86  patient before the rendering of such services and at any time
   87  requested by a patient.
   88         (b)This subsection may not be construed to assign any
   89  responsibility to a dentist of record for treatment rendered
   90  pursuant to a proper referral to another dentist who is not in
   91  the same practice with the dentist of record or to prohibit a
   92  patient from voluntarily selecting a new dentist without
   93  permission of the dentist of record.
   94         Section 4. Section 466.019, Florida Statutes, is amended to
   95  read:
   96         466.019 Advertising by dentists.—
   97         (1) As used in this section, the term “advertisement” means
   98  a representation disseminated in any manner or by any means to
   99  solicit patients and includes, but is not limited to, business
  100  cards, circulars, pamphlets, newspapers, websites, and social
  101  media.
  102         (2) The purpose of this section is to ensure that the
  103  public has access to information which provides a sufficient
  104  basis upon which to make an informed selection of dentists while
  105  also ensuring that the public is protected from false or
  106  misleading advertisements which would detract from a fair and
  107  rational selection process. The board shall adopt rules to carry
  108  out the intent of this section, the purpose of which shall be to
  109  regulate the manner of such advertising in keeping with the
  110  provisions hereof.
  111         (3)(2)An No advertisement by a licensed dentist may not
  112  shall contain any false, fraudulent, misleading, or deceptive
  113  statement or claim or any statement or claim which:
  114         (a) Contains misrepresentations of fact;
  115         (b) Is likely to mislead or deceive because in context it
  116  makes only a partial disclosure of relevant facts;
  117         (c) Contains laudatory statements about the dentist or
  118  group of dentists;
  119         (d) Is intended or is likely to create false, unjustified
  120  expectations of favorable results;
  121         (e) Relates to the quality of dental services provided as
  122  compared to other available dental services;
  123         (f) Is intended or is likely to appeal primarily to a
  124  layperson’s fears;
  125         (g) Contains fee information without a disclaimer that such
  126  is a minimum fee only; or
  127         (h) Contains other representations or implications that in
  128  reasonable probability will cause an ordinary, prudent person to
  129  misunderstand or to be deceived.
  130         (4) An advertisement of dental services provided through
  131  telehealth as defined in s. 456.47 must include a disclaimer
  132  that reads, in a clearly legible font and size, “An in-person
  133  examination with a dentist licensed under chapter 466, Florida
  134  Statutes, is recommended before beginning telehealth treatment
  135  in order to prevent injury or harm” for each of the following
  136  services, if advertised:
  137         (a) The taking of an impression or the digital scanning of
  138  the human tooth, teeth, or jaws by any means or method, directly
  139  or indirectly.
  140         (b)Furnishing, supplying, constructing, reproducing, or
  141  repairing any prosthetic denture, bridge, or appliance or any
  142  other structure designed to be worn in the human mouth.
  143         (c) Placing an appliance or a structure in the human mouth
  144  or adjusting or attempting to adjust the appliance or structure.
  145         (d) Correcting or attempting to correct malformations of
  146  teeth or jaws.
  147         (5)(3) For purposes of this section, D.D.S. or D.M.D. are
  148  synonymous and may be used interchangeably by licensed dentists
  149  who have graduated from an accredited American dental school
  150  with a D.D.S. or D.M.D. degree, when advertising dental
  151  services.
  152         Section 5. Present subsections (2) through (10) of section
  153  466.024, Florida Statutes, are redesignated as subsections (3)
  154  through (11), respectively, a new subsection (2) is added to
  155  that section, and present subsections (3), (5), (6), and (8) are
  156  amended, to read:
  157         466.024 Delegation of duties; expanded functions.—
  158         (2) Only a licensed dentist, a dental hygienist under
  159  general supervision, or a dental assistant under direct
  160  supervision may take an impression or perform digital scanning
  161  of the human tooth, teeth, or jaws, directly or indirectly and
  162  by any means or method, for the purpose of the practice of
  163  dentistry.
  164         (4)(3) For all remediable tasks listed in subsection (3)
  165  (2), the following disclaimer must be provided to the patient in
  166  writing 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         (6)(5) A dental hygienist who performs, without
  174  supervision, the remediable tasks listed in subsection (3) (2)
  175  shall:
  176         (a) Provide a dental referral in strict compliance with
  177  federal and state patient referral, anti-kickback, and patient
  178  brokering laws.
  179         (b) Encourage the establishment of a dental home.
  180         (c) Maintain professional malpractice insurance coverage
  181  that has minimum limits of $100,000 per occurrence and $300,000
  182  in the aggregate through the employing health access setting or
  183  individual policy.
  184         (7)(6) Notwithstanding subsection (1) or subsection (3)
  185  (2), a dentist may delegate the tasks of gingival curettage and
  186  root planing to a dental hygienist but not to a dental
  187  assistant.
  188         (9)(8) Notwithstanding subsection (1) or subsection (3)
  189  (2), a dentist may not delegate to anyone other than another
  190  licensed dentist:
  191         (a) Any prescription of drugs or medications requiring the
  192  written order or prescription of a licensed dentist or
  193  physician.
  194         (b) Any diagnosis for treatment or treatment planning.
  195         Section 6. Present paragraph (mm) of subsection (1) of
  196  section 466.028, Florida Statutes, is redesignated as paragraph
  197  (pp), and a new paragraph (mm) and paragraphs (nn) and (oo) are
  198  added to that subsection, to read:
  199         466.028 Grounds for disciplinary action; action by the
  200  board.—
  201         (1) The following acts constitute grounds for denial of a
  202  license or disciplinary action, as specified in s. 456.072(2):
  203         (mm) Failure by the dentist of record, before the initial
  204  diagnosis and correction of a malposition of human teeth or
  205  initial use of an orthodontic appliance, to perform an in-person
  206  examination of the patient or obtain records from an in-person
  207  examination within the last 6 months and to perform a review of
  208  the patient’s most recent diagnostic digital or conventional
  209  radiographs or other equivalent bone imaging suitable for
  210  orthodontia.
  211         (nn)For dental services provided in-person or through
  212  telehealth by an individual, a partnership, a corporation, or
  213  any other entity, failing to provide each patient with the name,
  214  contact telephone number, after-hours contact information for
  215  emergencies, and, upon the patient’s request, the license
  216  information of each dentist who is providing dental services to
  217  the patient.
  218         (oo)For dental services provided through telehealth by an
  219  individual, a partnership, a corporation, or any other entity,
  220  failing to designate a dentist of record and make available,
  221  before the rendering of such services and upon the patient’s
  222  request, the name, telephone number, practice address, and state
  223  license number for the dentist of record and any other dentist
  224  who will be involved in the provision of dental services to the
  225  patient through telehealth.
  226         Section 7. Subsection (6) of section 409.906, Florida
  227  Statutes, is amended to read:
  228         409.906 Optional Medicaid services.—Subject to specific
  229  appropriations, the agency may make payments for services which
  230  are optional to the state under Title XIX of the Social Security
  231  Act and are furnished by Medicaid providers to recipients who
  232  are determined to be eligible on the dates on which the services
  233  were provided. Any optional service that is provided shall be
  234  provided only when medically necessary and in accordance with
  235  state and federal law. Optional services rendered by providers
  236  in mobile units to Medicaid recipients may be restricted or
  237  prohibited by the agency. Nothing in this section shall be
  238  construed to prevent or limit the agency from adjusting fees,
  239  reimbursement rates, lengths of stay, number of visits, or
  240  number of services, or making any other adjustments necessary to
  241  comply with the availability of moneys and any limitations or
  242  directions provided for in the General Appropriations Act or
  243  chapter 216. If necessary to safeguard the state’s systems of
  244  providing services to elderly and disabled persons and subject
  245  to the notice and review provisions of s. 216.177, the Governor
  246  may direct the Agency for Health Care Administration to amend
  247  the Medicaid state plan to delete the optional Medicaid service
  248  known as “Intermediate Care Facilities for the Developmentally
  249  Disabled.” Optional services may include:
  250         (6) CHILDREN’S DENTAL SERVICES.—The agency may pay for
  251  diagnostic, preventive, or corrective procedures, including
  252  orthodontia in severe cases, provided to a recipient under age
  253  21, by or under the supervision of a licensed dentist. The
  254  agency may also reimburse a health access setting as defined in
  255  s. 466.003 for the remediable tasks that a licensed dental
  256  hygienist is authorized to perform under s. 466.024(3) s.
  257  466.024(2). Services provided under this program include
  258  treatment of the teeth and associated structures of the oral
  259  cavity, as well as treatment of disease, injury, or impairment
  260  that may affect the oral or general health of the individual.
  261  However, Medicaid will not provide reimbursement for dental
  262  services provided in a mobile dental unit, except for a mobile
  263  dental unit:
  264         (a) Owned by, operated by, or having a contractual
  265  agreement with the Department of Health and complying with
  266  Medicaid’s county health department clinic services program
  267  specifications as a county health department clinic services
  268  provider.
  269         (b) Owned by, operated by, or having a contractual
  270  arrangement with a federally qualified health center and
  271  complying with Medicaid’s federally qualified health center
  272  specifications as a federally qualified health center provider.
  273         (c) Rendering dental services to Medicaid recipients, 21
  274  years of age and older, at nursing facilities.
  275         (d) Owned by, operated by, or having a contractual
  276  agreement with a state-approved dental educational institution.
  277         Section 8. This act shall take effect July 1, 2023.