Amended in Assembly April 9, 2013

Amended in Assembly March 21, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 1174

Introduced by Assembly begin delete Member end delete begin insert Members end insert Bocanegra begin insert and Logue end insert

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. Dental professionals: teledentistry under Medi-Cal.

(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 begin insert , end insert 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 begin delete operate dental radiography equipment for the purpose of oral radiography, and end delete , 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.

Vote: majority. Appropriation: no. Fiscal committee: 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.

begin delete

(d) This section shall become operative on January 1, 2010.

end delete

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 begin delete carries end delete begin insert caries end insert
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 begin delete (2) end delete begin insert (3) end insert ,
and pursuant to the order, control, and full professional
responsibility of a licensed dentist.

begin insert

(2) A registered dental assistant in extended function may only
perform the functions authorized pursuant to paragraph (1) if he
or she has completed a board-approved registered dental assistant
in extended function education program in performing those
functions, or if he or she has provided evidence, satisfactory to
the board, of having completed a board-approved course in those
functions.

end insert begin delete

(2)

end delete

begin insert (3) end insert  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 subdivision (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.

begin delete

(e) Operate dental radiography equipment for the purpose of
oral radiography.

end delete begin delete

(f)

end delete

begin insert (e) end insert  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 begin delete carries end delete begin insert caries end insert 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.