Bill Text: CA AB1174 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Dental professionals.

Spectrum: Bipartisan Bill

Status: (Passed) 2014-09-27 - Chaptered by Secretary of State - Chapter 662, Statutes of 2014. [AB1174 Detail]

Download: California-2013-AB1174-Amended.html

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BILL NUMBER: AB 1174	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MARCH 21, 2013

INTRODUCED BY   Assembly Member Bocanegra

                        FEBRUARY 22, 2013

   An act  to amend Sections 1752.4, 1753.5, 1753.6, and 1910 of
the Business and Professions Code, and to add Section 14132.726 
 to the Welfare and Institution Code,   relating to oral
health.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1174, as amended, Bocanegra.  Oral health: virtual
dental homes.   Dental professionals: teledentistry
under Medi-Cal.  
   Existing 
    (1)    Existing  law, the Dental
Practice Act, establishes the Dental Board of California. Existing
law creates, within the jurisdiction of the board,  a Dental
Assisting Council that is responsible for the regulation of dental
assistants, registered dental assistants, and registered dental
assistants in extended functions   and  a Dental
Hygiene Committee of California, that is responsible for  the
 regulation of registered dental hygienists, registered dental
hygienists in alternative practice, and registered dental hygienists
in extended functions.  Existing law governs the scope of
practice for those professionals.  
   This bill would authorize a registered dental assistant to
determine which radiographs to perform if he or she has completed a
specified educational program. The bill would authorize a registered
dental assistant in extended functions licensed on or after January
1, 2010 to place interim therapeutic restorations, as defined,
pursuant to the order, control, and full professional responsibility
of a licensed dentist, as specified. The bill would authorize a
registered dental hygienist to operate dental radiography equipment
for the purpose of oral radiography, and, after submitting to the
committee evidence of satisfactory completion of a course of
instruction approved by the committee, determine which radiographs to
perform and place interim therapeutic restorations upon the order of
a licensed dentist.  
   (2) Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services,
including certain dental services, as specified. Existing law
provides that, to the extent that federal financial participation is
available, face-to-face contact between a health care provider and a
patient is not required under the Medi-Cal program for
"teleophthalmology and teledermatology by store and forward," as
defined to mean the asynchronous transmission of medical information
to be reviewed at a later time by a licensed physician or
optometrist, as specified, at a distant site.  
   This bill would enact similar provisions relating to the use of
teledentistry, as defined, under the Medi-Cal program. The bill would
provide that, to the extent that federal financial participation is
available, face-to-face contact between a health care provider and a
patient shall not be required under the Medi-Cal program for
"teledentistry by store and forward." The bill would define that term
to mean an asynchronous transmission of dental information to be
reviewed at a later time by a licensed dentist at a distant site,
where the dentist at the distant site reviews the dental information
without the patient being present in real time, as defined and as
specified. The bill would also provide that dentist participation in
services provided at an intermittent clinic, as defined, through the
use of telehealth, as defined, shall be considered a billable
encounter under Medi-Cal. The bill would also require, on or before
January 1, 2017, the department to report to the Legislature the
number and type of services provided, and the payments made related
to the application of teledentistry, as specified.  
   This bill would declare the intent of the Legislature to enact
legislation that would incorporate into law the new duties of dental
assistants and dental hygienists being tested in a specified pilot
project and address barriers to expanding the Virtual Dental Home
system of care, as specified, as a cost-effective mechanism to
improve the oral health of California's most underserved and
vulnerable citizens. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 1752.4 of the  
Business and Professions Code   is amended to read: 
   1752.4.  (a) A registered dental assistant may perform all of the
following duties:
   (1) All duties that a dental assistant is allowed to perform.
   (2) Mouth-mirror inspections of the oral cavity, to include
charting of obvious lesions, existing restorations, and missing
teeth.
   (3) Apply and activate bleaching agents using a nonlaser
light-curing device.
   (4) Use of automated caries detection devices and materials to
gather information for diagnosis by the dentist.
   (5) Obtain intraoral images for computer-aided design (CAD),
milled restorations.
   (6) Pulp vitality testing and recording of findings.
   (7) Place bases, liners, and bonding agents.
   (8) Chemically prepare teeth for bonding.
   (9) Place, adjust, and finish direct provisional restorations.
   (10) Fabricate, adjust, cement, and remove indirect provisional
restorations, including stainless steel crowns when used as a
provisional restoration.
   (11) Place post-extraction dressings after inspection of the
surgical site by the supervising licensed dentist.
   (12) Place periodontal dressings.
   (13) Dry endodontically treated canals using absorbent paper
points.
   (14) Adjust dentures extra-orally.
   (15) Remove excess cement from surfaces of teeth with a hand
instrument.
   (16) Polish coronal surfaces of the teeth.
   (17) Place ligature ties and archwires.
   (18) Remove orthodontic bands.
   (19) All duties that the board may prescribe by regulation.
   (b) A registered dental assistant may only perform the following
additional duties if he or she has completed a board-approved
registered dental assistant educational program in those duties, or
if he or she has provided evidence, satisfactory to the board, of
having completed a board-approved course in those duties.
   (1) Remove excess cement with an ultrasonic scaler from
supragingival surfaces of teeth undergoing orthodontic treatment.
   (2) The allowable duties of an orthodontic assistant permitholder
as specified in Section 1750.3. A registered dental assistant shall
not be required to complete further instruction in the duties of
placing ligature ties and archwires, removing orthodontic bands, and
removing excess cement from tooth surfaces with a hand instrument.
   (3) The allowable duties of a dental sedation assistant
permitholder as specified in Section 1750.5.
   (4) The application of pit and fissure sealants. 
   (5) Determine which radiographs to perform. 
   (c) Except as provided in Section 1777, the supervising licensed
dentist shall be responsible for determining whether each authorized
procedure performed by a registered dental assistant should be
performed under general or direct supervision.
   (d) This section shall become operative on January 1, 2010.
   SEC.   2.    Section 1753.5 of the 
 Business and Professions Code   is amended to read:

   1753.5.  (a) A registered dental assistant in extended functions
licensed on or after January 1, 2010, is authorized to perform all
duties and procedures that a registered dental assistant is
authorized to perform as specified in and limited by Section 1752.4,
and those duties that the board may prescribe by regulation.
   (b) A registered dental assistant in extended functions licensed
on or after January 1, 2010, is authorized to perform the following
additional procedures under direct supervision and pursuant to the
order, control, and full professional responsibility of a licensed
dentist:
   (1) Conduct preliminary evaluation of the patient's oral health,
including, but not limited to, charting, intraoral and extra-oral
evaluation of soft tissue, classifying occlusion, and myofunctional
evaluation.
   (2) Perform oral health assessments in school-based, community
health project settings under the direction of a dentist, registered
dental hygienist, or registered dental hygienist in alternative
practice.
   (3) Cord retraction of gingiva for impression procedures.
   (4) Size and fit endodontic master points and accessory points.
   (5) Cement endodontic master points and accessory points.
   (6) Take final impressions for permanent indirect restorations.
   (7) Take final impressions for tooth-borne removable prosthesis.
   (8) Polish and contour existing amalgam restorations.
   (9) Place, contour, finish, and adjust all direct restorations.
   (10) Adjust and cement permanent indirect restorations.
   (11) Other procedures authorized by regulations adopted by the
board.
   (c) All procedures required to be performed under direct
supervision shall be checked and approved by the supervising licensed
dentist prior to the patient's dismissal from the office. 
   (d) (1) A registered dental assistant in extended functions
licensed on or after January 1, 2010, is authorized to place interim
therapeutic restorations, defined as the removal of carries using
hand instruments and placement of an adhesive restorative material,
upon the order of the supervising dentist under general supervision,
except as authorized pursuant to paragraph (2), and pursuant to the
order, control, and full professional responsibility of a licensed
dentist.  
   (2) The supervising licensed dentist shall be responsible for
determining whether the functions authorized pursuant to paragraph
(1) may be performed under general or direct supervision. 
   SEC.   3.   Section 1753.6 of the  
Business and Professions Code   is amended to read: 
   1753.6.  (a) Each person who holds a license as a registered
dental assistant in extended functions on the operative date of this
section may only perform those procedures that a registered dental
assistant is allowed to perform as specified in and limited by
Section 1752.4, and the procedures specified in paragraphs (1) to
(6), inclusive, until he or she provides evidence of having completed
a board-approved course in the additional procedures specified in
paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision
(b)  , and paragraph (1) of subdi   vision (d),  of
Section 1753.5, and an examination as specified in Section 1753.4:
   (1) Cord retraction of gingiva for impression procedures.
   (2) Take final impressions for permanent indirect restorations.
   (3) Formulate indirect patterns for endodontic post and core
castings.
   (4) Fit trial endodontic filling points.
   (5) Apply pit and fissure sealants.
   (6) Remove excess cement from subgingival tooth surfaces with a
hand instrument.
   (b) This section shall become operative on January 1, 2010.
   SEC.  4.    Section 1910 of the  
Business and Professions Code   is amended to read: 
   1910.  A registered dental hygienist is authorized to perform the
following procedures under general supervision:
   (a) Preventive and therapeutic interventions, including oral
prophylaxis, scaling, and root planing.
   (b) Application of topical, therapeutic, and subgingival agents
used for the control of caries and periodontal disease.
   (c) The taking of impressions for bleaching trays and application
and activation of agents with nonlaser, light-curing devices.
   (d) The taking of impressions for bleaching trays and placements
of in-office, tooth-whitening devices. 
   (e) Operate dental radiography equipment for the purpose of oral
radiography.  
   (f) After submitting to the committee evidence of satisfactory
completion of a course of instruction approved by the committee, the
following:  
   (1) Determine which radiographs to perform.  
   (2) Place interim therapeutic restorations, defined as the removal
of carries using hand instruments and placement of an adhesive
restorative material, upon the order of a licensed dentist. 
   SEC. 5.    Section 14132.726 is added to the 
 Welfare and Institutions Code   , to read:  
   14132.726.  (a) To the extent that federal financial participation
is available, face-to-face contact between a health care provider
and a patient shall not be required under the Medi-Cal program for
teledentistry by store and forward. Services appropriately provided
through the store and forward process are subject to billing and
reimbursement policies developed by the department.
   (b) A patient receiving teledentistry by store and forward shall
be notified of the right to receive interactive communication with
the distant dentist, and shall receive an interactive communication
with the distant dentist, upon request. If requested, communication
with the distant dentist may occur either at the time of the
consultation, or within 30 days of the patient's notification of the
results of the consultation.
   (c) Dentist participation in services provided at an intermittent
clinic, as defined in Section 1206 of the Health and Safety Code,
through the use of telehealth, as defined in Section 2290.5 of the
Business and Professions Code, shall be considered a billable
encounter under Medi-Cal.
   (d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, and make specific this section
by means of all-county letters, provider bulletins, and similar
instructions.
   (e) On or before January 1, 2017, the department shall report to
the Legislature the number and type of services provided, and the
payments made related to the application of store and forward
teledentistry as provided, under this section as a Medi-Cal benefit.
   (f) For purposes of this section, the following definitions apply:

   (1) "Asynchronous store and forward" means the transmission of a
patient's dental information from an originating site to the health
care provider at a distant site without the presence of the patient.
   (2) "Distant site" means a site where a health care provider who
provides health care services is located while providing these
services via a telecommunications system.
   (3) "Health care provider" means a person who is licensed under
Chapter 4 (commencing with Section 1600) of Division 2 of the
Business and Professions Code.
   (4) "Originating site" means a site where a patient is located at
the time health care services are provided via a telecommunications
system or where the asynchronous store and forward service
originates.
   (5) "Synchronous interaction" means a real-time interaction
between a patient and a health care provider located at a distant
site.
   (6) "Teledentistry" means the mode of delivering dental health
care services and public dental health via information and
communication technologies to facilitate the diagnosis, consultation,
treatment, education, care management, and self-management of a
patient's dental health care while the patient is at the originating
site and the dental health care provider is at a distant site.
Teledentistry includes synchronous interactions and asynchronous
store and forward transfers.
   (7) "Teledentistry by store and forward" means an asynchronous
transmission of dental information to be reviewed at a later time by
a licensed dentist at a distant site, where the dentist at the
distant site reviews the dental information without the patient being
present in real time.  
  SECTION 1.    (a) The Legislature finds and
declares the following:
   (1) Significant portions of California's population suffer from
significant oral health disparities. Untreated dental disease can
have serious consequences for overall health and the ability to be a
productive member of society.
   (2) Reports from the United States Surgeon General and the
Institute of Medicine of the National Academics indicate that these
oral health disparities tend to be concentrated in people with low
incomes, disadvantaged children, individuals with disabilities and
chronic medical conditions, dependent older adults, and people living
in rural areas.
   (3) Approximately one-fourth of all children in California have
never visited a dental office and two-thirds of all children in the
state suffer from poor oral health by the time they reach the 3rd
grade.
   (4) Low-income adults no longer have coverage under the state's
Denti-Cal program for other than emergency services and too many of
them are stigmatized by having missing teeth, miss work because of
dental infections, or end up in hospital emergency departments.
   (5) A new model of delivering oral health services, called the
Virtual Dental Home, has been demonstrating a community-based,
prevention-focused, telehealth-facilitated system of care in
California, supported by the Health Workforce Pilot Project No. 172,
administered by the Office of Statewide Health Planning and
Development.
   (6) The Virtual Dental Home system of care brings care to
community locations where the most underserved and vulnerable
children and adults receive educational, social, and general health
services. It emphasizes prevention and early intervention and targets
those at highest risk for developing dental disease. This system
delivers oral health at a very low cost per child or adult and has
the potential to save the state overall oral health expenses.
   (b) It is the intent of the Legislature to enact legislation to
incorporate the new duties of dental assistants and dental hygienists
being tested in the Health Workforce Pilot Project No. 172 into law
and to address barriers to expanding the Virtual Dental Home system
of care as a cost-effective mechanism to improve the oral health of
California's most underserved and vulnerable citizens.