Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 684
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Children, Families, and Elder Affairs (Rader)
       recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete lines 621 - 852
    4  and insert:
    5         (7)A dental therapist under the direct or indirect
    6  supervision of a dentist may administer local anesthesia,
    7  including intraoral block anesthesia or soft tissue infiltration
    8  anesthesia, or both, if she or he has completed the course
    9  described in subsection (5) and presents evidence of current
   10  certification in basic or advanced cardiac life support.
   11         (8)(7) A licensed dentist, or a dental therapist who is
   12  authorized by her or his supervising dentist, may utilize an X
   13  ray machine, expose dental X-ray films, and interpret or read
   14  such films. Notwithstanding The provisions of part IV of chapter
   15  468 to the contrary notwithstanding, a licensed dentist, or a
   16  dental therapist who is authorized by her or his supervising
   17  dentist, may authorize or direct a dental assistant to operate
   18  such equipment and expose such films under her or his direction
   19  and supervision, pursuant to rules adopted by the board in
   20  accordance with s. 466.024 which ensure that said assistant is
   21  competent by reason of training and experience to operate said
   22  equipment in a safe and efficient manner. The board may charge a
   23  fee not to exceed $35 to defray the cost of verifying compliance
   24  with requirements adopted pursuant to this section.
   25         (9)(8)Notwithstanding The provisions of s. 465.0276
   26  notwithstanding, a dentist need not register with the board or
   27  comply with the continuing education requirements of that
   28  section if the dentist confines her or his dispensing activity
   29  to the dispensing of fluorides and chlorhexidine chlorohexidine
   30  rinse solutions; provided that the dentist complies with and is
   31  subject to all laws and rules applicable to pharmacists and
   32  pharmacies, including, but not limited to, chapters 465, 499,
   33  and 893, and all applicable federal laws and regulations, when
   34  dispensing such products.
   35         Section 13. Subsection (1) of section 466.018, Florida
   36  Statutes, is amended to read:
   37         466.018 Dentist of record; patient records.—
   38         (1) Each patient shall have a dentist of record. The
   39  dentist of record shall remain primarily responsible for all
   40  dental treatment on such patient regardless of whether the
   41  treatment is rendered by the dentist or by another dentist,
   42  dental therapist, dental hygienist, or dental assistant
   43  rendering such treatment in conjunction with, at the direction
   44  or request of, or under the supervision of such dentist of
   45  record. The dentist of record shall be identified in the record
   46  of the patient. If treatment is rendered by a dentist other than
   47  the dentist of record or by a dental hygienist, dental
   48  therapist, or dental assistant, the name or initials of such
   49  person shall be placed in the record of the patient. In any
   50  disciplinary proceeding brought pursuant to this chapter or
   51  chapter 456, it shall be presumed as a matter of law that
   52  treatment was rendered by the dentist of record unless otherwise
   53  noted on the patient record pursuant to this section. The
   54  dentist of record and any other treating dentist are subject to
   55  discipline pursuant to this chapter or chapter 456 for treatment
   56  rendered to the patient and performed in violation of such
   57  chapter. One of the purposes of this section is to ensure that
   58  the responsibility for each patient is assigned to one dentist
   59  in a multidentist practice of any nature and to assign primary
   60  responsibility to the dentist for treatment rendered by a dental
   61  hygienist, dental therapist, or dental assistant under her or
   62  his supervision. This section shall not be construed to assign
   63  any responsibility to a dentist of record for treatment rendered
   64  pursuant to a proper referral to another dentist who does not in
   65  practice with the dentist of record or to prohibit a patient
   66  from voluntarily selecting a new dentist without permission of
   67  the dentist of record.
   68         Section 14. Section 466.0225, Florida Statutes, is created
   69  to read:
   70         466.0225Examination of dental therapists; licensing.—
   71         (1)Any person desiring to be licensed as a dental
   72  therapist shall apply to the department to take the licensure
   73  examinations and shall verify the information required on the
   74  application by oath. The application must include two recent
   75  photographs of the applicant.
   76         (2)An applicant is entitled to take the examinations
   77  required in this section and receive licensure to practice
   78  dental therapy in this state if the applicant:
   79         (a)Is 18 years of age or older;
   80         (b)Is a graduate of a dental therapy college or school
   81  accredited by the American Dental Association Commission on
   82  Dental Accreditation or its successor entity, if any, or any
   83  other dental therapy accrediting entity recognized by the United
   84  States Department of Education. For applicants applying for a
   85  dental therapy license before January 1, 2024, the board shall
   86  approve the applicant’s dental therapy education program if the
   87  program was administered by a college or school that operates an
   88  accredited dental or dental hygiene program and the college or
   89  school certifies to the board that the applicant’s education
   90  substantially conformed to the education standards established
   91  by the American Dental Association Commission on Dental
   92  Accreditation;
   93         (c)Has successfully completed a dental therapy practical
   94  or clinical examination produced by the American Board of Dental
   95  Examiners, Inc., (ADEX) or its successor entity, if any, if the
   96  board finds that the successor entity’s examination meets or
   97  exceeds the provisions of this section. If an applicant fails to
   98  pass the ADEX Dental Therapy Examination after three attempts,
   99  the applicant is not eligible to retake the examination unless
  100  the applicant completes additional education requirements as
  101  specified by the board. If a dental therapy examination has not
  102  been established by the ADEX, the board shall administer or
  103  approve an alternative examination;
  104         (d)Has not been disciplined by a board, except for
  105  citation offenses or minor violations;
  106         (e)Has not been convicted of or pled nolo contendere to,
  107  regardless of adjudication, any felony or misdemeanor related to
  108  the practice of a health care profession; and
  109         (f)Has successfully completed a written examination on the
  110  laws and rules of this state regulating the practice of dental
  111  therapy.
  112         (3)An applicant who meets the requirements of this
  113  section, and who has successfully completed the examinations
  114  identified in paragraph (2)(c) in a jurisdiction other than this
  115  state, or who has successfully completed comparable examinations
  116  administered or approved by the licensing authority in a
  117  jurisdiction other than this state shall be licensed to practice
  118  dental therapy in this state if the board determines that the
  119  other jurisdiction’s examinations and scope of practice are
  120  substantially similar to those identified in paragraph (2)(c).
  121         Section 15. Section 466.0227, Florida Statutes, is created
  122  to read:
  123         466.0227Dental therapists; scope and area of practice.—
  124         (1)The Legislature finds that authorizing licensed dental
  125  therapists to perform the services specified in subsection (3)
  126  would improve access to high-quality affordable oral health
  127  services for all residents in this state. The Legislature
  128  intends to rapidly improve such access for low-income,
  129  uninsured, and underserved patients and communities. To further
  130  this intent, a dental therapist licensed under this chapter is
  131  limited to practicing dental therapy in the following settings:
  132         (a)A health access setting, as defined in s. 466.003(16).
  133         (b)A community health center, including an off-site care
  134  setting.
  135         (c)A nursing facility.
  136         (d)A military or veterans’ hospital or clinic, including
  137  an off-site care setting.
  138         (e)A governmental or public health clinic, including an
  139  off-site care setting.
  140         (f)A school, Head Start program, or school-based
  141  prevention program, as defined in s. 466.003(17).
  142         (g)An oral health education institution, including an off
  143  site care setting.
  144         (h)A hospital.
  145         (i)A geographic area designated as a dental health
  146  professional shortage area by the state or the Federal
  147  Government which is not located within a federally designated
  148  metropolitan statistical area.
  149         (2)Except as otherwise provided in this chapter, a dental
  150  therapist may perform the dental therapy services as specified
  151  in subsection (3) under the direct or indirect supervision of a
  152  dentist to the extent authorized by the supervising dentist and
  153  provided within the terms of a written collaborative management
  154  agreement signed by the dental therapist and the supervising
  155  dentist which meets the requirements of subsection (4). For
  156  purposes of this section, the term:
  157         (a) “Direct supervision” means supervision whereby a
  158  dentist diagnoses the condition to be treated, a dentist
  159  authorizes the procedure to be performed, a dentist remains on
  160  the premises while the procedures are performed, and a dentist
  161  approves the work performed before dismissal of the patient.
  162         (b) “Indirect supervision” means supervision whereby a
  163  dentist authorizes the procedure and a dentist is on the
  164  premises while the procedure is performed.
  165         (3)Dental therapy services include all of the following:
  166         (a)All services, treatments, and competencies identified
  167  by the American Dental Association Commission on Dental
  168  Accreditation in its Dental Therapy Education Accreditation
  169  Standards.
  170         (b)The following state-specific services, if the dental
  171  therapist’s education included curriculum content satisfying the
  172  American Dental Association Commission on Dental Accreditation
  173  criteria for state-specific dental therapy services:
  174         1.Evaluating radiographs.
  175         2.Placement of space maintainers.
  176         3.Pulpotomies on primary teeth.
  177         4.Dispensing and administering nonopioid analgesics
  178  including nitrous oxide, anti-inflammatories, and antibiotics as
  179  authorized by the supervising dentist and within the parameters
  180  of the collaborative management agreement.
  181         5.Oral evaluation and assessment of dental disease and
  182  formulation of an individualized treatment plan if authorized by
  183  a supervising dentist and subject to any conditions,
  184  limitations, and protocols specified by the supervising dentist
  185  in the collaborative management agreement.
  186         (4)Before performing any of the services authorized in
  187  subsection (3), a dental therapist must enter into a written
  188  collaborative management agreement with a supervising dentist.
  189  The agreement must be signed by the dental therapist and the
  190  supervising dentist and must include:
  191         (a)Practice settings where services may be provided by the
  192  dental therapist and the populations to be served by the dental
  193  therapist.
  194         (b)Any limitations on the services that may be provided by
  195  the dental therapist, including the level of supervision
  196  required by the supervising dentist.
  197         (c)Age- and procedure-specific practice protocols for the
  198  dental therapist, including case selection criteria, assessment
  199  guidelines, and imaging frequency.
  200         (d)A procedure for creating and maintaining dental records
  201  for the patients who are treated by the dental therapist.
  202         (e)A plan to manage medical emergencies in each practice
  203  setting where the dental therapist provides care.
  204         (f)A quality assurance plan for monitoring care provided
  205  by the dental therapist, including patient care review, referral
  206  followup, and a quality assurance chart review.
  207         (g)Protocols for the dental therapist to administer and
  208  dispense medications, including the specific conditions and
  209  circumstances under which the medications are to be dispensed
  210  and administered.
  211         (h)Criteria relating to the provision of care by the
  212  dental therapist to patients with specific medical conditions or
  213  complex medication histories, including requirements for
  214  consultation before the initiation of care.
  215         (i)Supervision criteria of dental therapists.
  216         (j)A plan for the provision of clinical resources and
  217  referrals in situations that are beyond the capabilities of the
  218  dental therapist.
  219         (5)A supervising dentist may restrict or limit the dental
  220  therapist’s practice in a collaborative management agreement to
  221  be less than the full scope of practice for dental therapists
  222  which is authorized in subsection (3).
  223         (6)A supervising dentist may authorize a dental therapist
  224  to provide dental therapy services to a patient before the
  225  dentist examines or diagnoses the patient if the authority,
  226  conditions, and protocols are established in a written
  227  collaborative management agreement and if the patient is
  228  subsequently referred to a dentist for any needed additional
  229  services that exceed the dental therapist’s scope of practice or
  230  authorization under the collaborative management agreement.
  231         (7)A supervising dentist must be licensed and practicing
  233  ================= T I T L E  A M E N D M E N T ================
  234  And the title is amended as follows:
  235         Delete lines 48 - 72
  236  and insert:
  237         direct or indirect supervision of a dentist to
  238         administer local anesthesia and utilize an X-ray
  239         machine, expose dental X-ray films, and interpret or
  240         read such films if specified requirements are met;
  241         correcting a term; amending s. 466.018, F.S.;
  242         providing that a dentist remains primarily responsible
  243         for the dental treatment of a patient regardless of
  244         whether the treatment is provided by a dental
  245         therapist; requiring the initials of a dental
  246         therapist who renders treatment to a patient to be
  247         placed in the record of the patient; creating s.
  248         466.0225, F.S.; providing application requirements and
  249         examination and licensure qualifications for dental
  250         therapists; creating s. 466.0227, F.S.; providing
  251         legislative findings and intent; limiting the practice
  252         of dental therapy to specified settings; authorizing a
  253         dental therapist to perform specified services under
  254         the direct or indirect supervision of a dentist under
  255         certain conditions; defining the terms “direct
  256         supervision” and “indirect supervision”; specifying
  257         state-specific dental therapy services; requiring a
  258         collaborative management agreement to be signed by a
  259         supervising dentist and a dental therapist and to
  260         include certain information;