Florida Senate - 2020                                     SB 152
       
       
        
       By Senator Brandes
       
       
       
       
       
       24-00156-20                                            2020152__
    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 setting or program;
    7         amending s. 466.001, F.S.; revising legislative
    8         purpose and intent; amending s. 466.002, F.S.;
    9         providing applicability; amending s. 466.003, F.S.;
   10         defining the terms “dental therapist” and “dental
   11         therapy”; revising the definition of the term “health
   12         access setting” to include certain dental therapy
   13         programs; amending s. 466.004, F.S.; requiring the
   14         chair of the Board of Dentistry to appoint a Council
   15         on Dental Therapy effective after a specified
   16         timeframe; providing for membership, meetings, and the
   17         purpose of the council; amending s. 466.006, F.S.;
   18         revising the definition of the terms “full-time
   19         practice” and “full-time practice of dentistry within
   20         the geographic boundaries of this state within 1 year”
   21         to include full-time faculty members of certain dental
   22         therapy schools; amending s. 466.0075, F.S.;
   23         authorizing the board to require any person who
   24         applies to take the examination to practice dental
   25         therapy in this state to maintain medical malpractice
   26         insurance in a certain amount; amending s. 466.009,
   27         F.S.; requiring the Department of Health to allow any
   28         person who fails the dental therapy examination to
   29         retake the examination; providing that a person who
   30         fails a practical or clinical examination to practice
   31         dental therapy and who has failed one part or
   32         procedure of the examination may be required to retake
   33         only that part or procedure to pass the examination;
   34         amending s. 466.011, F.S.; requiring the board to
   35         certify applicants for licensure as a dental
   36         therapist; creating s. 466.0136, F.S.; requiring the
   37         board to require each licensed dental therapist to
   38         complete a specified number of hours of continuing
   39         education; 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 and operate an X-ray machine, expose dental
   50         X-ray films, and interpret or read such films if
   51         specified requirements are met; correcting a term;
   52         amending s. 466.018, F.S.; providing that a dentist
   53         remains primarily responsible for the dental treatment
   54         of a patient regardless of whether the treatment is
   55         provided by a dental therapist; requiring the initials
   56         of a dental therapist who renders treatment to a
   57         patient to be placed in the record of the patient;
   58         creating s. 466.0225, F.S.; providing application
   59         requirements and examination and licensure
   60         qualifications for dental therapists; creating s.
   61         466.0227, F.S.; providing legislative findings and
   62         intent; limiting the practice of dental therapy to
   63         specified settings; authorizing a dental therapist to
   64         perform specified services under the general
   65         supervision of a dentist under certain conditions;
   66         specifying state-specific dental therapy services;
   67         requiring a collaborative management agreement to be
   68         signed by a supervising dentist and a dental therapist
   69         and to include certain information; requiring the
   70         supervising dentist to determine the number of hours
   71         of practice that a dental therapist must complete
   72         before performing certain authorized services;
   73         authorizing a supervising dentist to restrict or limit
   74         the dental therapist’s practice in a collaborative
   75         management agreement; providing that a supervising
   76         dentist may authorize a dental therapist to provide
   77         dental therapy services to a patient before the
   78         dentist examines or diagnoses the patient under
   79         certain conditions; requiring a supervising dentist to
   80         be licensed and practicing in this state; specifying
   81         that the supervising dentist is responsible for
   82         certain services; amending s. 466.026, F.S.; providing
   83         criminal penalties for practicing dental therapy
   84         without an active license, selling or offering to sell
   85         a diploma from a dental therapy school or college,
   86         falsely using a specified name or initials or holding
   87         herself or himself out as an actively licensed dental
   88         therapist; amending s. 466.028, F.S.; revising grounds
   89         for denial of a license or disciplinary action to
   90         include the practice of dental therapy; amending s.
   91         466.0285, F.S.; prohibiting persons other than
   92         licensed dentists from employing a dental therapist in
   93         the operation of a dental office and from controlling
   94         the use of any dental equipment or material in certain
   95         circumstances; requiring the department, in
   96         consultation with the board and the Agency for Health
   97         Care Administration, to provide reports to the
   98         Legislature by specified dates; requiring that certain
   99         information and recommendations be included in the
  100         reports; providing an effective date.
  101          
  102  Be It Enacted by the Legislature of the State of Florida:
  103  
  104         Section 1. Paragraph (c) of subsection (1) of section
  105  409.906, Florida Statutes, is amended, and paragraph (e) is
  106  added to subsection (6) of that section, to read:
  107         409.906 Optional Medicaid services.—Subject to specific
  108  appropriations, the agency may make payments for services which
  109  are optional to the state under Title XIX of the Social Security
  110  Act and are furnished by Medicaid providers to recipients who
  111  are determined to be eligible on the dates on which the services
  112  were provided. Any optional service that is provided shall be
  113  provided only when medically necessary and in accordance with
  114  state and federal law. Optional services rendered by providers
  115  in mobile units to Medicaid recipients may be restricted or
  116  prohibited by the agency. Nothing in this section shall be
  117  construed to prevent or limit the agency from adjusting fees,
  118  reimbursement rates, lengths of stay, number of visits, or
  119  number of services, or making any other adjustments necessary to
  120  comply with the availability of moneys and any limitations or
  121  directions provided for in the General Appropriations Act or
  122  chapter 216. If necessary to safeguard the state’s systems of
  123  providing services to elderly and disabled persons and subject
  124  to the notice and review provisions of s. 216.177, the Governor
  125  may direct the Agency for Health Care Administration to amend
  126  the Medicaid state plan to delete the optional Medicaid service
  127  known as “Intermediate Care Facilities for the Developmentally
  128  Disabled.” Optional services may include:
  129         (1) ADULT DENTAL SERVICES.—
  130         (c) However, Medicaid will not provide reimbursement for
  131  dental services provided in a mobile dental unit, except for a
  132  mobile dental unit:
  133         1. Owned by, operated by, or having a contractual agreement
  134  with the Department of Health and complying with Medicaid’s
  135  county health department clinic services program specifications
  136  as a county health department clinic services provider.
  137         2. Owned by, operated by, or having a contractual
  138  arrangement with a federally qualified health center and
  139  complying with Medicaid’s federally qualified health center
  140  specifications as a federally qualified health center provider.
  141         3. Rendering dental services to Medicaid recipients, 21
  142  years of age and older, at nursing facilities.
  143         4. Owned by, operated by, or having a contractual agreement
  144  with a state-approved dental educational institution.
  145         5.Owned by, operated by, or having a contractual agreement
  146  with a health access setting, as defined in s. 466.003(16), or a
  147  similar setting or program that serves underserved or vulnerable
  148  populations that face serious barriers to accessing dental
  149  services, which may include, but is not limited to, Early Head
  150  Start programs, homeless shelters, schools, and the Special
  151  Supplemental Nutrition Program for Women, Infants, and Children.
  152         (6) CHILDREN’S DENTAL SERVICES.—The agency may pay for
  153  diagnostic, preventive, or corrective procedures, including
  154  orthodontia in severe cases, provided to a recipient under age
  155  21, by or under the supervision of a licensed dentist. The
  156  agency may also reimburse a health access setting as defined in
  157  s. 466.003(16) s. 466.003 for the remediable tasks that a
  158  licensed dental hygienist is authorized to perform under s.
  159  466.024(2). Services provided under this program include
  160  treatment of the teeth and associated structures of the oral
  161  cavity, as well as treatment of disease, injury, or impairment
  162  that may affect the oral or general health of the individual.
  163  However, Medicaid will not provide reimbursement for dental
  164  services provided in a mobile dental unit, except for a mobile
  165  dental unit:
  166         (e)Owned by, operated by, or having a contractual
  167  agreement with a health access setting, as defined in s.
  168  466.003(16), or a similar setting or program that serves
  169  underserved or vulnerable populations that face serious barriers
  170  to accessing dental services, which may include, but is not
  171  limited to, Early Head Start programs, homeless shelters,
  172  schools, and the Special Supplemental Nutrition Program for
  173  Women, Infants, and Children.
  174         Section 2. Section 466.001, Florida Statutes, is amended to
  175  read:
  176         466.001 Legislative purpose and intent.—The legislative
  177  purpose for enacting this chapter is to ensure that every
  178  dentist, dental therapist, or dental hygienist practicing in
  179  this state meets minimum requirements for safe practice without
  180  undue clinical interference by persons not licensed under this
  181  chapter. It is the legislative intent that dental services be
  182  provided only in accordance with the provisions of this chapter
  183  and not be delegated to unauthorized individuals. It is the
  184  further legislative intent that dentists, dental therapists, and
  185  dental hygienists who fall below minimum competency or who
  186  otherwise present a danger to the public shall be prohibited
  187  from practicing in this state. All provisions of this chapter
  188  relating to the practice of dentistry, dental therapy, and
  189  dental hygiene shall be liberally construed to carry out such
  190  purpose and intent.
  191         Section 3. Subsections (5) and (6) of section 466.002,
  192  Florida Statutes, are amended to read:
  193         466.002 Persons exempt from operation of chapter.—Nothing
  194  in this chapter shall apply to the following practices, acts,
  195  and operations:
  196         (5) Students in Florida schools of dentistry, dental
  197  therapy, and dental hygiene or dental assistant educational
  198  programs, while performing regularly assigned work under the
  199  curriculum of such schools.
  200         (6) Instructors in Florida schools of dentistry,
  201  instructors in dental programs that prepare persons holding
  202  D.D.S. or D.M.D. degrees for certification by a specialty board
  203  and that are accredited in the United States by January 1, 2005,
  204  in the same manner as the board recognizes accreditation for
  205  Florida schools of dentistry that are not otherwise affiliated
  206  with a Florida school of dentistry, or instructors in Florida
  207  schools of dental hygiene or dental therapy or dental assistant
  208  educational programs, while performing regularly assigned
  209  instructional duties under the curriculum of such schools or
  210  programs. A full-time dental instructor at a dental school or
  211  dental program approved by the board may be allowed to practice
  212  dentistry at the teaching facilities of such school or program,
  213  upon receiving a teaching permit issued by the board, in strict
  214  compliance with such rules as are adopted by the board
  215  pertaining to the teaching permit and with the established rules
  216  and procedures of the dental school or program as recognized in
  217  this section.
  218         Section 4. Present subsections (7) through (15) of section
  219  466.003, Florida Statutes, are redesignated as subsections (9)
  220  through (17), respectively, present subsections (14) and (15)
  221  are amended, and new subsections (7) and (8) are added to that
  222  section, to read:
  223         466.003 Definitions.—As used in this chapter:
  224         (7)“Dental therapist” means a person licensed to practice
  225  dental therapy pursuant to s. 466.0225.
  226         (8)“Dental therapy” means the rendering of services
  227  pursuant to s. 466.0227 and any related extraoral services or
  228  procedures required in the performance of such services.
  229         (16)(14) “Health access setting” means a program or an
  230  institution of the Department of Children and Families, the
  231  Department of Health, the Department of Juvenile Justice, a
  232  nonprofit community health center, a Head Start center, a
  233  federally qualified health center or look-alike as defined by
  234  federal law, a school-based prevention program, a clinic
  235  operated by an accredited college of dentistry, or an accredited
  236  dental hygiene or dental therapy program in this state if such
  237  community service program or institution immediately reports to
  238  the Board of Dentistry all violations of s. 466.027, s. 466.028,
  239  or other practice act or standard of care violations related to
  240  the actions or inactions of a dentist, dental hygienist, dental
  241  therapist, or dental assistant engaged in the delivery of dental
  242  care in such setting.
  243         (17)(15) “School-based prevention program” means preventive
  244  oral health services offered at a school by one of the entities
  245  defined in subsection (16) (14) or by a nonprofit organization
  246  that is exempt from federal income taxation under s. 501(a) of
  247  the Internal Revenue Code, and described in s. 501(c)(3) of the
  248  Internal Revenue Code.
  249         Section 5. Subsection (2) of section 466.004, Florida
  250  Statutes, is amended to read:
  251         466.004 Board of Dentistry.—
  252         (2) To advise the board, it is the intent of the
  253  Legislature that councils be appointed as specified in
  254  paragraphs (a)-(d) (a), (b), and (c). The department shall
  255  provide administrative support to the councils and shall provide
  256  public notice of meetings and agenda of the councils. Councils
  257  shall include at least one board member who shall chair the
  258  council and shall include nonboard members. All council members
  259  shall be appointed by the board chair. Council members shall be
  260  appointed for 4-year terms, and all members shall be eligible
  261  for reimbursement of expenses in the manner of board members.
  262         (a) A Council on Dental Hygiene shall be appointed by the
  263  board chair and shall include one dental hygienist member of the
  264  board, who shall chair the council, one dental member of the
  265  board, and three dental hygienists who are actively engaged in
  266  the practice of dental hygiene in this state. In making the
  267  appointments, the chair shall consider recommendations from the
  268  Florida Dental Hygiene Association. The council shall meet at
  269  the request of the board chair, a majority of the members of the
  270  board, or the council chair; however, the council must meet at
  271  least three times a year. The council is charged with the
  272  responsibility of and shall meet for the purpose of developing
  273  rules and policies for recommendation to the board, which the
  274  board shall consider, on matters pertaining to that part of
  275  dentistry consisting of educational, preventive, or therapeutic
  276  dental hygiene services; dental hygiene licensure, discipline,
  277  or regulation; and dental hygiene education. Rule and policy
  278  recommendations of the council shall be considered by the board
  279  at its next regularly scheduled meeting in the same manner in
  280  which it considers rule and policy recommendations from
  281  designated subcommittees of the board. Any rule or policy
  282  proposed by the board pertaining to the specified part of
  283  dentistry defined by this subsection shall be referred to the
  284  council for a recommendation before final action by the board.
  285  The board may take final action on rules pertaining to the
  286  specified part of dentistry defined by this subsection without a
  287  council recommendation if the council fails to submit a
  288  recommendation in a timely fashion as prescribed by the board.
  289         (b) A Council on Dental Assisting shall be appointed by the
  290  board chair and shall include one board member who shall chair
  291  the council and three dental assistants who are actively engaged
  292  in dental assisting in this state. The council shall meet at the
  293  request of the board chair or a majority of the members of the
  294  board. The council shall meet for the purpose of developing
  295  recommendations to the board on matters pertaining to that part
  296  of dentistry related to dental assisting.
  297         (c)Effective 28 months after the first dental therapy
  298  license is granted by the board, a Council on Dental Therapy
  299  shall be appointed by the board chair and shall include one
  300  board member who shall chair the council and three dental
  301  therapists who are actively engaged in the practice of dental
  302  therapy in this state. The council shall meet at the request of
  303  the board chair, a majority of the members of the board, or the
  304  council chair; however, the council must meet at least three
  305  times per year. The council is charged with the responsibility
  306  of, and shall meet for the purpose of, developing rules and
  307  policies for recommendation to the board on matters pertaining
  308  to that part of dentistry consisting of educational,
  309  preventative, or therapeutic dental therapy services; dental
  310  therapy licensure, discipline, or regulation; and dental therapy
  311  education. Rule and policy recommendations of the council must
  312  be considered by the board at its next regularly scheduled
  313  meeting in the same manner in which it considers rule and policy
  314  recommendations from designated subcommittees of the board. Any
  315  rule or policy proposed by the board pertaining to the specified
  316  part of dentistry defined by this subsection must be referred to
  317  the council for a recommendation before final action by the
  318  board. The board may take final action on rules pertaining to
  319  the specified part of dentistry defined by this subsection
  320  without a council recommendation if the council fails to submit
  321  a recommendation in a timely fashion as prescribed by the board.
  322         (d)(c) With the concurrence of the State Surgeon General,
  323  the board chair may create and abolish other advisory councils
  324  relating to dental subjects, including, but not limited to:
  325  examinations, access to dental care, indigent care, nursing home
  326  and institutional care, public health, disciplinary guidelines,
  327  and other subjects as appropriate. Such councils shall be
  328  appointed by the board chair and shall include at least one
  329  board member who shall serve as chair.
  330         Section 6. Subsection (4) and paragraph (b) of subsection
  331  (6) of section 466.006, Florida Statutes, are amended to read:
  332         466.006 Examination of dentists.—
  333         (4) Notwithstanding any other provision of law in chapter
  334  456 pertaining to the clinical dental licensure examination or
  335  national examinations, to be licensed as a dentist in this
  336  state, an applicant must successfully complete the following:
  337         (a) A written examination on the laws and rules of the
  338  state regulating the practice of dentistry;
  339         (b)1. A practical or clinical examination, which shall be
  340  the American Dental Licensing Examination produced by the
  341  American Board of Dental Examiners, Inc., or its successor
  342  entity, if any, that is administered in this state and graded by
  343  dentists licensed in this state and employed by the department
  344  for just such purpose, provided that the board has attained, and
  345  continues to maintain thereafter, representation on the board of
  346  directors of the American Board of Dental Examiners, the
  347  examination development committee of the American Board of
  348  Dental Examiners, and such other committees of the American
  349  Board of Dental Examiners as the board deems appropriate by rule
  350  to assure that the standards established herein are maintained
  351  organizationally. A passing score on the American Dental
  352  Licensing Examination administered in this state and graded by
  353  dentists who are licensed in this state is valid for 365 days
  354  after the date the official examination results are published.
  355         2.a. As an alternative to the requirements of subparagraph
  356  1., an applicant may submit scores from an American Dental
  357  Licensing Examination previously administered in a jurisdiction
  358  other than this state after October 1, 2011, and such
  359  examination results shall be recognized as valid for the purpose
  360  of licensure in this state. A passing score on the American
  361  Dental Licensing Examination administered out-of-state shall be
  362  the same as the passing score for the American Dental Licensing
  363  Examination administered in this state and graded by dentists
  364  who are licensed in this state. The examination results are
  365  valid for 365 days after the date the official examination
  366  results are published. The applicant must have completed the
  367  examination after October 1, 2011.
  368         b. This subparagraph may not be given retroactive
  369  application.
  370         3. If the date of an applicant’s passing American Dental
  371  Licensing Examination scores from an examination previously
  372  administered in a jurisdiction other than this state under
  373  subparagraph 2. is older than 365 days, then such scores shall
  374  nevertheless be recognized as valid for the purpose of licensure
  375  in this state, but only if the applicant demonstrates that all
  376  of the following additional standards have been met:
  377         a.(I) The applicant completed the American Dental Licensing
  378  Examination after October 1, 2011.
  379         (II) This sub-subparagraph may not be given retroactive
  380  application;
  381         b. The applicant graduated from a dental school accredited
  382  by the American Dental Association Commission on Dental
  383  Accreditation or its successor entity, if any, or any other
  384  dental accrediting organization recognized by the United States
  385  Department of Education. Provided, however, if the applicant did
  386  not graduate from such a dental school, the applicant may submit
  387  proof of having successfully completed a full-time supplemental
  388  general dentistry program accredited by the American Dental
  389  Association Commission on Dental Accreditation of at least 2
  390  consecutive academic years at such accredited sponsoring
  391  institution. Such program must provide didactic and clinical
  392  education at the level of a D.D.S. or D.M.D. program accredited
  393  by the American Dental Association Commission on Dental
  394  Accreditation;
  395         c. The applicant currently possesses a valid and active
  396  dental license in good standing, with no restriction, which has
  397  never been revoked, suspended, restricted, or otherwise
  398  disciplined, from another state or territory of the United
  399  States, the District of Columbia, or the Commonwealth of Puerto
  400  Rico;
  401         d. The applicant submits proof that he or she has never
  402  been reported to the National Practitioner Data Bank, the
  403  Healthcare Integrity and Protection Data Bank, or the American
  404  Association of Dental Boards Clearinghouse. This sub
  405  subparagraph does not apply if the applicant successfully
  406  appealed to have his or her name removed from the data banks of
  407  these agencies;
  408         e.(I) In the 5 years immediately preceding the date of
  409  application for licensure in this state, the applicant must
  410  submit proof of having been consecutively engaged in the full
  411  time practice of dentistry in another state or territory of the
  412  United States, the District of Columbia, or the Commonwealth of
  413  Puerto Rico, or, if the applicant has been licensed in another
  414  state or territory of the United States, the District of
  415  Columbia, or the Commonwealth of Puerto Rico for less than 5
  416  years, the applicant must submit proof of having been engaged in
  417  the full-time practice of dentistry since the date of his or her
  418  initial licensure.
  419         (II) As used in this section, “full-time practice” is
  420  defined as a minimum of 1,200 hours per year for each and every
  421  year in the consecutive 5-year period or, where applicable, the
  422  period since initial licensure, and must include any combination
  423  of the following:
  424         (A) Active clinical practice of dentistry providing direct
  425  patient care.
  426         (B) Full-time practice as a faculty member employed by a
  427  dental, dental therapy, or dental hygiene school approved by the
  428  board or accredited by the American Dental Association
  429  Commission on Dental Accreditation.
  430         (C) Full-time practice as a student at a postgraduate
  431  dental education program approved by the board or accredited by
  432  the American Dental Association Commission on Dental
  433  Accreditation.
  434         (III) The board shall develop rules to determine what type
  435  of proof of full-time practice is required and to recoup the
  436  cost to the board of verifying full-time practice under this
  437  section. Such proof must, at a minimum, be:
  438         (A) Admissible as evidence in an administrative proceeding;
  439         (B) Submitted in writing;
  440         (C) Submitted by the applicant under oath with penalties of
  441  perjury attached;
  442         (D) Further documented by an affidavit of someone unrelated
  443  to the applicant who is familiar with the applicant’s practice
  444  and testifies with particularity that the applicant has been
  445  engaged in full-time practice; and
  446         (E) Specifically found by the board to be both credible and
  447  admissible.
  448         (IV) An affidavit of only the applicant is not acceptable
  449  proof of full-time practice unless it is further attested to by
  450  someone unrelated to the applicant who has personal knowledge of
  451  the applicant’s practice. If the board deems it necessary to
  452  assess credibility or accuracy, the board may require the
  453  applicant or the applicant’s witnesses to appear before the
  454  board and give oral testimony under oath;
  455         f. The applicant must submit documentation that he or she
  456  has completed, or will complete, prior to licensure in this
  457  state, continuing education equivalent to this state’s
  458  requirements for the last full reporting biennium;
  459         g. The applicant must prove that he or she has never been
  460  convicted of, or pled nolo contendere to, regardless of
  461  adjudication, any felony or misdemeanor related to the practice
  462  of a health care profession in any jurisdiction;
  463         h. The applicant must successfully pass a written
  464  examination on the laws and rules of this state regulating the
  465  practice of dentistry and must successfully pass the computer
  466  based diagnostic skills examination; and
  467         i. The applicant must submit documentation that he or she
  468  has successfully completed the National Board of Dental
  469  Examiners dental examination.
  470         (6)
  471         (b)1. As used in this section, “full-time practice of
  472  dentistry within the geographic boundaries of this state within
  473  1 year” is defined as a minimum of 1,200 hours in the initial
  474  year of licensure, which must include any combination of the
  475  following:
  476         a. Active clinical practice of dentistry providing direct
  477  patient care within the geographic boundaries of this state.
  478         b. Full-time practice as a faculty member employed by a
  479  dental, dental therapy, or dental hygiene school approved by the
  480  board or accredited by the American Dental Association
  481  Commission on Dental Accreditation and located within the
  482  geographic boundaries of this state.
  483         c. Full-time practice as a student at a postgraduate dental
  484  education program approved by the board or accredited by the
  485  American Dental Association Commission on Dental Accreditation
  486  and located within the geographic boundaries of this state.
  487         2. The board shall develop rules to determine what type of
  488  proof of full-time practice of dentistry within the geographic
  489  boundaries of this state for 1 year is required in order to
  490  maintain active licensure and shall develop rules to recoup the
  491  cost to the board of verifying maintenance of such full-time
  492  practice under this section. Such proof must, at a minimum:
  493         a. Be admissible as evidence in an administrative
  494  proceeding;
  495         b. Be submitted in writing;
  496         c. Be submitted by the applicant under oath with penalties
  497  of perjury attached;
  498         d. Be further documented by an affidavit of someone
  499  unrelated to the applicant who is familiar with the applicant’s
  500  practice and testifies with particularity that the applicant has
  501  been engaged in full-time practice of dentistry within the
  502  geographic boundaries of this state within the last 365 days;
  503  and
  504         e. Include such additional proof as specifically found by
  505  the board to be both credible and admissible.
  506         3. An affidavit of only the applicant is not acceptable
  507  proof of full-time practice of dentistry within the geographic
  508  boundaries of this state within 1 year, unless it is further
  509  attested to by someone unrelated to the applicant who has
  510  personal knowledge of the applicant’s practice within the last
  511  365 days. If the board deems it necessary to assess credibility
  512  or accuracy, the board may require the applicant or the
  513  applicant’s witnesses to appear before the board and give oral
  514  testimony under oath.
  515         Section 7. Section 466.0075, Florida Statutes, is amended
  516  to read:
  517         466.0075 Applicants for examination; medical malpractice
  518  insurance.—The board may require any person applying to take the
  519  examination to practice dentistry in this state, the examination
  520  to practice dental therapy in this state, or the examination to
  521  practice dental hygiene in this state to maintain medical
  522  malpractice insurance in amounts sufficient to cover any
  523  incident of harm to a patient during the clinical examination.
  524         Section 8. Subsection (1) of section 466.009, Florida
  525  Statutes, is amended, and subsection (4) is added to that
  526  section, to read:
  527         466.009 Reexamination.—
  528         (1) The department shall allow permit any person who fails
  529  an examination that which is required under s. 466.006, or s.
  530  466.007, or s. 466.0225 to retake the examination. If the
  531  examination to be retaken is a practical or clinical
  532  examination, the applicant shall pay a reexamination fee set by
  533  rule of the board in an amount not to exceed the original
  534  examination fee.
  535         (4)If an applicant for a license to practice dental
  536  therapy fails the practical or clinical examination and has
  537  failed one part or procedure of such examination, she or he may
  538  be required to retake only that part or procedure to pass such
  539  examination. However, if any such applicant fails more than one
  540  part or procedure of any such examination, she or he must be
  541  required to retake the entire examination.
  542         Section 9. Section 466.011, Florida Statutes, is amended to
  543  read:
  544         466.011 Licensure.—The board shall certify for licensure by
  545  the department any applicant who satisfies the requirements of
  546  s. 466.006, s. 466.0067, or s. 466.007, or s. 466.0225. The
  547  board may refuse to certify an applicant who has violated any of
  548  the provisions of s. 466.026 or s. 466.028.
  549         Section 10. Section 466.0136, Florida Statutes, is created
  550  to read:
  551         466.0136Continuing education; dental therapists.—In
  552  addition to any other requirements for relicensure for dental
  553  therapists specified in this chapter, the board shall require
  554  each licensed dental therapist to complete at least 24 hours,
  555  but not more than 36 hours, biennially of continuing education
  556  in dental subjects in programs approved by the board or in
  557  equivalent programs of continuing education. Programs of
  558  continuing education approved by the board must be programs of
  559  learning that, in the opinion of the board, contribute directly
  560  to the dental education of the dental therapist. An individual
  561  who is licensed as both a dental therapist and a dental
  562  hygienist may use 1 hour of continuing education that is
  563  approved for both dental therapy and dental hygiene education to
  564  satisfy both dental therapy and dental hygiene continuing
  565  education requirements. The board shall adopt rules and
  566  guidelines to administer and enforce this section. The dental
  567  therapist shall retain in her or his records any receipts,
  568  vouchers, or certificates necessary to document completion of
  569  the continuing education. Compliance with the continuing
  570  education requirements is mandatory for issuance of the renewal
  571  certificate. The board may excuse licensees, as a group or as
  572  individuals, from all or part of the continuing education
  573  requirements if an unusual circumstance, emergency, or hardship
  574  prevented compliance with this section.
  575         Section 11. Section 466.016, Florida Statutes, is amended
  576  to read:
  577         466.016 License to be displayed.—Every practitioner of
  578  dentistry, dental therapy, or dental hygiene within the meaning
  579  of this chapter shall post and keep conspicuously displayed her
  580  or his license in the office where wherein she or he practices,
  581  in plain sight of the practitioner’s patients. Any dentist,
  582  dental therapist, or dental hygienist who practices at more than
  583  one location shall be required to display a copy of her or his
  584  license in each office where she or he practices.
  585         Section 12. Present subsections (7) and (8) of section
  586  466.017, Florida Statutes, are redesignated as subsections (8)
  587  and (9), respectively, paragraphs (d) and (e) of subsection (3),
  588  subsection (4), and present subsections (7) and (8) of that
  589  section are amended, and a new subsection (7) is added to that
  590  section, to read:
  591         466.017 Prescription of drugs; anesthesia.—
  592         (3) The board shall adopt rules which:
  593         (d) Establish further requirements relating to the use of
  594  general anesthesia or sedation, including, but not limited to,
  595  office equipment and the training of dental assistants, dental
  596  therapists, or dental hygienists who work with dentists using
  597  general anesthesia or sedation.
  598         (e) Establish an administrative mechanism enabling the
  599  board to verify compliance with training, education, experience,
  600  equipment, or certification requirements of dentists, dental
  601  therapists, dental hygienists, and dental assistants adopted
  602  pursuant to this subsection. The board may charge a fee to
  603  defray the cost of verifying compliance with requirements
  604  adopted pursuant to this paragraph.
  605         (4) A dentist, dental therapist, or dental hygienist who
  606  administers or employs the use of any form of anesthesia must
  607  possess a certification in either basic cardiopulmonary
  608  resuscitation for health professionals or advanced cardiac life
  609  support approved by the American Heart Association or the
  610  American Red Cross or an equivalent agency-sponsored course with
  611  recertification every 2 years. Each dental office that which
  612  uses any form of anesthesia must have immediately available and
  613  in good working order such resuscitative equipment, oxygen, and
  614  other resuscitative drugs as are specified by rule of the board
  615  in order to manage possible adverse reactions.
  616         (7)A dental therapist under the general supervision of a
  617  dentist may administer local anesthesia, including intraoral
  618  block anesthesia or soft tissue infiltration anesthesia, or
  619  both, if she or he has completed the course described in
  620  subsection (5) and presents evidence of current certification in
  621  basic or advanced cardiac life support.
  622         (8)(7) A licensed dentist, or a dental therapist who is
  623  authorized by her or his supervising dentist, may operate
  624  utilize an X-ray machine, expose dental X-ray films, and
  625  interpret or read such films. Notwithstanding The provisions of
  626  part IV of chapter 468 to the contrary notwithstanding, a
  627  licensed dentist, or a dental therapist who is authorized by her
  628  or his supervising dentist, may authorize or direct a dental
  629  assistant to operate such equipment and expose such films under
  630  her or his direction and supervision, pursuant to rules adopted
  631  by the board in accordance with s. 466.024 which ensure that the
  632  said assistant is competent by reason of training and experience
  633  to operate the X-ray said equipment in a safe and efficient
  634  manner. The board may charge a fee not to exceed $35 to defray
  635  the cost of verifying compliance with requirements adopted
  636  pursuant to this section.
  637         (9)(8)Notwithstanding The provisions of s. 465.0276
  638  notwithstanding, a dentist need not register with the board or
  639  comply with the continuing education requirements of that
  640  section if the dentist confines her or his dispensing activity
  641  to the dispensing of fluorides and chlorhexidine chlorohexidine
  642  rinse solutions; provided that the dentist complies with and is
  643  subject to all laws and rules applicable to pharmacists and
  644  pharmacies, including, but not limited to, chapters 465, 499,
  645  and 893, and all applicable federal laws and regulations, when
  646  dispensing such products.
  647         Section 13. Subsection (1) of section 466.018, Florida
  648  Statutes, is amended to read:
  649         466.018 Dentist of record; patient records.—
  650         (1) Each patient shall have a dentist of record. The
  651  dentist of record shall remain primarily responsible for all
  652  dental treatment on such patient regardless of whether the
  653  treatment is rendered by the dentist or by another dentist,
  654  dental therapist, dental hygienist, or dental assistant
  655  rendering such treatment in conjunction with, at the direction
  656  or request of, or under the supervision of such dentist of
  657  record. The dentist of record shall be identified in the record
  658  of the patient. If treatment is rendered by a dentist other than
  659  the dentist of record or by a dental hygienist, dental
  660  therapist, or dental assistant, the name or initials of such
  661  person shall be placed in the record of the patient. In any
  662  disciplinary proceeding brought pursuant to this chapter or
  663  chapter 456, it shall be presumed as a matter of law that
  664  treatment was rendered by the dentist of record unless otherwise
  665  noted on the patient record pursuant to this section. The
  666  dentist of record and any other treating dentist are subject to
  667  discipline pursuant to this chapter or chapter 456 for treatment
  668  rendered to the patient and performed in violation of such
  669  chapter. One of the purposes of this section is to ensure that
  670  the responsibility for each patient is assigned to one dentist
  671  in a multidentist practice of any nature and to assign primary
  672  responsibility to the dentist for treatment rendered by a dental
  673  hygienist, dental therapist, or dental assistant under her or
  674  his supervision. This section shall not be construed to assign
  675  any responsibility to a dentist of record for treatment rendered
  676  pursuant to a proper referral to another dentist who does not in
  677  practice with the dentist of record or to prohibit a patient
  678  from voluntarily selecting a new dentist without permission of
  679  the dentist of record.
  680         Section 14. Section 466.0225, Florida Statutes, is created
  681  to read:
  682         466.0225Examination of dental therapists; licensing.—
  683         (1)Any person desiring to be licensed as a dental
  684  therapist must apply to the department to take the licensure
  685  examinations and shall verify the information required on the
  686  application by oath. The application must include two recent
  687  photographs of the applicant.
  688         (2)An applicant is entitled to take the examinations
  689  required under this section and receive licensure to practice
  690  dental therapy in this state if the applicant:
  691         (a)Is 18 years of age or older;
  692         (b)Is a graduate of a dental therapy college or school
  693  accredited by the American Dental Association Commission on
  694  Dental Accreditation or its successor entity, if any, or any
  695  other dental therapy accrediting entity recognized by the United
  696  States Department of Education. For applicants applying for a
  697  dental therapy license before January 1, 2025, the board shall
  698  approve the applicant’s dental therapy education program if the
  699  program was administered by a college or school that operates an
  700  accredited dental or dental hygiene program and the college or
  701  school certifies to the board that the applicant’s education
  702  substantially conformed to the education standards established
  703  by the American Dental Association Commission on Dental
  704  Accreditation;
  705         (c)Has successfully completed a dental therapy practical
  706  or clinical examination produced by the American Board of Dental
  707  Examiners, Inc., (ADEX) or its successor entity, if any, if the
  708  board finds that the successor entity’s examination meets or
  709  exceeds the provisions of this section. If an applicant fails to
  710  pass such an examination after three attempts, the applicant is
  711  not eligible to retake the examination unless the applicant
  712  completes additional education requirements as specified by the
  713  board. If a dental therapy examination has not been established
  714  by the ADEX, the board shall administer or approve an
  715  alternative examination;
  716         (d)Has not been disciplined by a board, except for
  717  citation offenses or minor violations;
  718         (e)Has not been convicted of or pled nolo contendere to,
  719  regardless of adjudication, any felony or misdemeanor related to
  720  the practice of a health care profession; and
  721         (f)Has successfully completed a written examination on the
  722  laws and rules of this state regulating the practice of dental
  723  therapy.
  724         (3)An applicant who meets the requirements of this section
  725  and who has successfully completed the examinations identified
  726  in paragraph (2)(c) in a jurisdiction other than this state, or
  727  who has successfully completed comparable examinations
  728  administered or approved by the licensing authority in a
  729  jurisdiction other than this state, shall be licensed to
  730  practice dental therapy in this state if the board determines
  731  that the other jurisdiction’s examinations and scope of practice
  732  are substantially similar to those identified in paragraph
  733  (2)(c).
  734         Section 15. Section 466.0227, Florida Statutes, is created
  735  to read:
  736         466.0227Dental therapists; scope and area of practice.—
  737         (1)The Legislature finds that authorizing licensed dental
  738  therapists to perform the services specified in subsection (3)
  739  would improve access to high-quality, affordable oral health
  740  services for all residents in this state. The Legislature
  741  intends to rapidly improve such access for low-income,
  742  uninsured, and underserved patients and communities. To further
  743  this intent, a dental therapist licensed under this chapter is
  744  limited to practicing dental therapy in the following settings:
  745         (a)A health access setting, as defined in s. 466.003(16).
  746         (b)A community health center, including an off-site care
  747  setting.
  748         (c)A nursing facility.
  749         (d)A military or veterans’ hospital or clinic, including
  750  an off-site care setting.
  751         (e)A governmental or public health clinic, including an
  752  off-site care setting.
  753         (f)A school, Head Start program, or school-based
  754  prevention program, as defined in s. 466.003(17).
  755         (g)An oral health education institution, including an off
  756  site care setting.
  757         (h)A hospital.
  758         (i)A geographic area designated as a dental health
  759  professional shortage area by the state or the Federal
  760  Government which is not located within a federally designated
  761  metropolitan statistical area.
  762         (j)Any other clinic or practice setting if at least 50
  763  percent of the patients served by the dental therapist in such
  764  clinic or practice setting:
  765         1.Are enrolled in Medicaid or another state or local
  766  governmental health care program for low-income or uninsured
  767  patients; or
  768         2.Do not have dental insurance and report a gross annual
  769  income that is less than 200 percent of the applicable federal
  770  poverty guidelines.
  771         (2)Except as otherwise provided in this chapter, a dental
  772  therapist may perform the dental therapy services specified in
  773  subsection (3) under the general supervision of a dentist to the
  774  extent authorized by the supervising dentist and provided within
  775  the terms of a written collaborative management agreement signed
  776  by the dental therapist and the supervising dentist which meets
  777  the requirements of subsection (4).
  778         (3)Dental therapy services include all of the following:
  779         (a)All services, treatments, and competencies identified
  780  by the American Dental Association Commission on Dental
  781  Accreditation in its Dental Therapy Education Accreditation
  782  Standards.
  783         (b)The following state-specific services, if the dental
  784  therapist’s education included curriculum content satisfying the
  785  American Dental Association Commission on Dental Accreditation
  786  criteria for state-specific dental therapy services:
  787         1.Evaluating radiographs.
  788         2.Placement of space maintainers.
  789         3.Pulpotomies on primary teeth.
  790         4.Dispensing and administering nonopioid analgesics
  791  including nitrous oxide, anti-inflammatories, and antibiotics as
  792  authorized by the supervising dentist and within the parameters
  793  of the collaborative management agreement.
  794         5.Oral evaluation and assessment of dental disease and
  795  formulation of an individualized treatment plan if authorized by
  796  a supervising dentist and subject to any conditions,
  797  limitations, and protocols specified by the supervising dentist
  798  in the collaborative management agreement.
  799         (4)Before performing any of the services authorized in
  800  subsection (3), a dental therapist must enter into a written
  801  collaborative management agreement with a supervising dentist.
  802  The agreement must be signed by the dental therapist and the
  803  supervising dentist and must include:
  804         (a)Practice settings where services may be provided by the
  805  dental therapist and the populations to be served by the dental
  806  therapist.
  807         (b)Any limitations on the services that may be provided by
  808  the dental therapist, including the level of supervision
  809  required by the supervising dentist.
  810         (c)Age- and procedure-specific practice protocols for the
  811  dental therapist, including case selection criteria, assessment
  812  guidelines, and imaging frequency.
  813         (d)A procedure for creating and maintaining dental records
  814  for the patients who are treated by the dental therapist.
  815         (e)A plan to manage medical emergencies in each practice
  816  setting where the dental therapist provides care.
  817         (f)A quality assurance plan for monitoring care provided
  818  by the dental therapist, including patient care review, referral
  819  followup, and a quality assurance chart review.
  820         (g)Protocols for the dental therapist to administer and
  821  dispense medications, including the specific conditions and
  822  circumstances under which the medications are to be dispensed
  823  and administered.
  824         (h)Criteria relating to the provision of care by the
  825  dental therapist to patients with specific medical conditions or
  826  complex medication histories, including requirements for
  827  consultation before the initiation of care.
  828         (i)Supervision criteria of dental therapists.
  829         (j)A plan for the provision of clinical resources and
  830  referrals in situations that are beyond the capabilities of the
  831  dental therapist.
  832         (5)A supervising dentist shall determine the number of
  833  hours of practice a dental therapist must complete under direct
  834  or indirect supervision of the supervising dentist before the
  835  dental therapist may perform any of the services authorized in
  836  subsection (3) under general supervision.
  837         (6)A supervising dentist may restrict or limit the dental
  838  therapist’s practice in a collaborative management agreement to
  839  be less than the full scope of practice for dental therapists
  840  which is authorized in subsection (3).
  841         (7)A supervising dentist may authorize a dental therapist
  842  to provide dental therapy services to a patient before the
  843  dentist examines or diagnoses the patient if the authority,
  844  conditions, and protocols are established in a written
  845  collaborative management agreement and if the patient is
  846  subsequently referred to a dentist for any needed additional
  847  services that exceed the dental therapist’s scope of practice or
  848  authorization under the collaborative management agreement.
  849         (8)A supervising dentist must be licensed and practicing
  850  in this state. The supervising dentist is responsible for all
  851  services authorized and performed by the dental therapist
  852  pursuant to the collaborative management agreement and for
  853  providing or arranging followup services to be provided by a
  854  dentist for those services that are beyond the dental
  855  therapist’s scope of practice and authorization under the
  856  collaborative management agreement.
  857         Section 16. Section 466.026, Florida Statutes, is amended
  858  to read:
  859         466.026 Prohibitions; penalties.—
  860         (1) Each of the following acts constitutes a felony of the
  861  third degree, punishable as provided in s. 775.082, s. 775.083,
  862  or s. 775.084:
  863         (a) Practicing dentistry, dental therapy, or dental hygiene
  864  unless the person has an appropriate, active license issued by
  865  the department pursuant to this chapter.
  866         (b) Using or attempting to use a license issued pursuant to
  867  this chapter which license has been suspended or revoked.
  868         (c) Knowingly employing any person to perform duties
  869  outside the scope allowed such person under this chapter or the
  870  rules of the board.
  871         (d) Giving false or forged evidence to the department or
  872  board for the purpose of obtaining a license.
  873         (e) Selling or offering to sell a diploma conferring a
  874  degree from a dental college, or dental hygiene school or
  875  college, or dental therapy school or college, or a license
  876  issued pursuant to this chapter, or procuring such diploma or
  877  license with intent that it shall be used as evidence of that
  878  which the document stands for, by a person other than the one
  879  upon whom it was conferred or to whom it was granted.
  880         (2) Each of the following acts constitutes a misdemeanor of
  881  the first degree, punishable as provided in s. 775.082 or s.
  882  775.083:
  883         (a) Using the name or title “dentist,” the letters “D.D.S.”
  884  or “D.M.D.”, or any other words, letters, title, or descriptive
  885  matter which in any way represents a person as being able to
  886  diagnose, treat, prescribe, or operate for any disease, pain,
  887  deformity, deficiency, injury, or physical condition of the
  888  teeth or jaws or oral-maxillofacial region unless the person has
  889  an active dentist’s license issued by the department pursuant to
  890  this chapter.
  891         (b) Using the name “dental hygienist” or the initials
  892  “R.D.H.” or otherwise holding herself or himself out as an
  893  actively licensed dental hygienist or implying to any patient or
  894  consumer that she or he is an actively licensed dental hygienist
  895  unless that person has an active dental hygienist’s license
  896  issued by the department pursuant to this chapter.
  897         (c)Using the name “dental therapist” or the initials
  898  “D.T.” or otherwise holding herself or himself out as an
  899  actively licensed dental therapist or implying to any patient or
  900  consumer that she or he is an actively licensed dental therapist
  901  unless that person has an active dental therapist’s license
  902  issued by the department pursuant to this chapter.
  903         (d)(c) Presenting as her or his own the license of another.
  904         (e)(d) Knowingly concealing information relative to
  905  violations of this chapter.
  906         (f)(e) Performing any services as a dental assistant as
  907  defined herein, except in the office of a licensed dentist,
  908  unless authorized by this chapter or by rule of the board.
  909         Section 17. Paragraphs (b), (c), (g), (s), and (t) of
  910  subsection (1) of section 466.028, Florida Statutes, are amended
  911  to read:
  912         466.028 Grounds for disciplinary action; action by the
  913  board.—
  914         (1) The following acts constitute grounds for denial of a
  915  license or disciplinary action, as specified in s. 456.072(2):
  916         (b) Having a license to practice dentistry, dental therapy,
  917  or dental hygiene revoked, suspended, or otherwise acted
  918  against, including the denial of licensure, by the licensing
  919  authority of another state, territory, or country.
  920         (c) Being convicted or found guilty of or entering a plea
  921  of nolo contendere to, regardless of adjudication, a crime in
  922  any jurisdiction which relates to the practice of dentistry,
  923  dental therapy, or dental hygiene. A plea of nolo contendere
  924  shall create a rebuttable presumption of guilt to the underlying
  925  criminal charges.
  926         (g) Aiding, assisting, procuring, or advising any
  927  unlicensed person to practice dentistry, dental therapy, or
  928  dental hygiene contrary to this chapter or to a rule of the
  929  department or the board.
  930         (s) Being unable to practice her or his profession with
  931  reasonable skill and safety to patients by reason of illness or
  932  use of alcohol, drugs, narcotics, chemicals, or any other type
  933  of material or as a result of any mental or physical condition.
  934  In enforcing this paragraph, the department shall have, upon a
  935  finding of the State Surgeon General or her or his designee that
  936  probable cause exists to believe that the licensee is unable to
  937  practice dentistry, dental therapy, or dental hygiene because of
  938  the reasons stated in this paragraph, the authority to issue an
  939  order to compel a licensee to submit to a mental or physical
  940  examination by physicians designated by the department. If the
  941  licensee refuses to comply with such order, the department’s
  942  order directing such examination may be enforced by filing a
  943  petition for enforcement in the circuit court where the licensee
  944  resides or does business. The licensee against whom the petition
  945  is filed shall not be named or identified by initials in any
  946  public court records or documents, and the proceedings shall be
  947  closed to the public. The department shall be entitled to the
  948  summary procedure provided in s. 51.011. A licensee affected
  949  under this paragraph shall at reasonable intervals be afforded
  950  an opportunity to demonstrate that she or he can resume the
  951  competent practice of her or his profession with reasonable
  952  skill and safety to patients.
  953         (t) Fraud, deceit, or misconduct in the practice of
  954  dentistry, dental therapy, or dental hygiene.
  955         Section 18. Paragraphs (a) and (b) of subsection (1) of
  956  section 466.0285, Florida Statutes, are amended to read:
  957         466.0285 Proprietorship by nondentists.—
  958         (1) No person other than a dentist licensed pursuant to
  959  this chapter, nor any entity other than a professional
  960  corporation or limited liability company composed of dentists,
  961  may:
  962         (a) Employ a dentist, a dental therapist, or a dental
  963  hygienist in the operation of a dental office.
  964         (b) Control the use of any dental equipment or material
  965  while such equipment or material is being used for the provision
  966  of dental services, whether those services are provided by a
  967  dentist, a dental therapist, a dental hygienist, or a dental
  968  assistant.
  969  
  970  Any lease agreement, rental agreement, or other arrangement
  971  between a nondentist and a dentist whereby the nondentist
  972  provides the dentist with dental equipment or dental materials
  973  shall contain a provision whereby the dentist expressly
  974  maintains complete care, custody, and control of the equipment
  975  or practice.
  976         Section 19. The Department of Health, in consultation with
  977  the Board of Dentistry and the Agency for Health Care
  978  Administration, shall submit a progress report to the President
  979  of the Senate and the Speaker of the House of Representatives by
  980  July 1, 2023, and a final report 3 years after the first dental
  981  therapy license is issued. The reports must include all of the
  982  following components:
  983         (1)The progress that has been made in this state to
  984  implement dental therapy training programs, licensing, and
  985  Medicaid reimbursement.
  986         (2)Data demonstrating the effects of dental therapy in
  987  this state on:
  988         (a)Patient access to dental services;
  989         (b)The use of primary and preventive dental services in
  990  underserved regions and populations, including the Medicaid
  991  population;
  992         (c)Costs to dental providers, patients, dental insurance
  993  carriers, and the state; and
  994         (d)The quality and safety of dental services.
  995         (3)Specific recommendations for any necessary legislative,
  996  administrative, or regulatory reform relating to the practice of
  997  dental therapy.
  998         (4)Any other information the department deems appropriate.
  999         Section 20. This act shall take effect July 1, 2020.