Amended in Assembly January 6, 2014

Amended in Assembly April 9, 2013

Amended in Assembly March 21, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 1174


Introduced by Assembly Members Bocanegra and Logue

February 22, 2013


An act to amend Sections 1752.4,begin delete 1753.5, 1753.6, andend delete 1910begin insert, and 1926 of, to amend, repeal, and add Section 1753.6end insert ofbegin insert, and to add, repeal, and add Sections 1753.55, 1910.5, and 1926.05 of,end insert the Business and Professions Code, and tobegin delete add Section 14132.726 toend deletebegin insert amend Section 14132.725 ofend insert the Welfare andbegin delete Institutionend deletebegin insert Institutionsend insert 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 assistantbegin insert who has completed a specified educational programend insert to determine which radiographs to performbegin delete if he or she has completed a specified educational programend delete. The bill would authorize a registered dental assistant in extended functions licensed on or after January 1, 2010,begin delete 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, after submitting to the committee evidence of satisfactory completion of a course of instruction approved by the committee, determine whichend deletebegin insert a registered dental hygienist, and a registered dental hygienist in alternative practice to chooseend insert radiographsbegin delete to performend delete and placebegin delete interim therapeuticend deletebegin insert protectiveend insert restorationsbegin delete upon the order of a licensed dentistend deletebegin delete.end deletebegin insert, as specified.end insert

(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.

begin delete

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.

end delete
begin insert

This bill would additionally provide that face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for teledentistry by store and forward, as defined.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P3    1

SECTION 1.  

Section 1752.4 of the Business and Professions
2Code
is amended to read:

3

1752.4.  

(a) A registered dental assistant may perform all of
4the following duties:

5(1) All duties that a dental assistant is allowed to perform.

6(2) Mouth-mirror inspections of the oral cavity, to include
7charting of obvious lesions, existing restorations, and missing
8teeth.

9(3) Apply and activate bleaching agents using a nonlaser
10light-curing device.

11(4) Use of automated caries detection devices and materials to
12gather information for diagnosis by the dentist.

13(5) Obtain intraoral images for computer-aided design (CAD),
14milled restorations.

15(6) Pulp vitality testing and recording of findings.

16(7) Place bases, liners, and bonding agents.

17(8) Chemically prepare teeth for bonding.

18(9) Place, adjust, and finish direct provisional restorations.

19(10) Fabricate, adjust, cement, and remove indirect provisional
20restorations, including stainless steel crowns when used as a
21provisional restoration.

22(11) Place postextraction dressings after inspection of the
23surgical site by the supervising licensed dentist.

24(12) Place periodontal dressings.

25(13) Dry endodontically treated canals using absorbent paper
26points.

27(14) Adjust dentures extra-orally.

28(15) Remove excess cement from surfaces of teeth with a hand
29instrument.

30(16) Polish coronal surfaces of the teeth.

31(17) Place ligature ties and archwires.

32(18) Remove orthodontic bands.

P4    1(19) All duties that the board may prescribe by regulation.

2(b) A registered dental assistant may only perform the following
3additional duties if he or she has completed a board-approved
4registered dental assistant educational program in those duties, or
5if he or she has provided evidence, satisfactory to the board, of
6having completed a board-approved course in thosebegin delete duties.end deletebegin insert duties:end insert

7(1) Remove excess cement with an ultrasonic scaler from
8supragingival surfaces of teeth undergoing orthodontic treatment.

9(2) The allowable duties of an orthodontic assistant permitholder
10as specified in Section 1750.3. A registered dental assistant shall
11not be required to complete further instruction in the duties of
12placing ligature ties and archwires, removing orthodontic bands,
13and removing excess cement from tooth surfaces with a hand
14instrument.

15(3) The allowable duties of a dental sedation assistant
16permitholder as specified in Section 1750.5.

17(4) The application of pit and fissure sealants.

18(5) Determine which radiographs to perform.

19(c) Except as provided in Section 1777, the supervising licensed
20dentist shall be responsible for determining whether each
21authorized procedure performed by a registered dental assistant
22should be performed under general or direct supervision.

begin delete
23

SEC. 2.  

Section 1753.5 of the Business and Professions Code
24 is amended to read:

25

1753.5.  

(a) A registered dental assistant in extended functions
26licensed on or after January 1, 2010, is authorized to perform all
27duties and procedures that a registered dental assistant is authorized
28to perform as specified in and limited by Section 1752.4, and those
29duties that the board may prescribe by regulation.

30(b) A registered dental assistant in extended functions licensed
31on or after January 1, 2010, is authorized to perform the following
32additional procedures under direct supervision and pursuant to the
33order, control, and full professional responsibility of a licensed
34dentist:

35(1) Conduct preliminary evaluation of the patient’s oral health,
36including, but not limited to, charting, intraoral and extra-oral
37evaluation of soft tissue, classifying occlusion, and myofunctional
38evaluation.

39(2) Perform oral health assessments in school-based, community
40health project settings under the direction of a dentist, registered
P5    1dental hygienist, or registered dental hygienist in alternative
2practice.

3(3) Cord retraction of gingiva for impression procedures.

4(4) Size and fit endodontic master points and accessory points.

5(5) Cement endodontic master points and accessory points.

6(6) Take final impressions for permanent indirect restorations.

7(7) Take final impressions for tooth-borne removable prosthesis.

8(8) Polish and contour existing amalgam restorations.

9(9) Place, contour, finish, and adjust all direct restorations.

10(10) Adjust and cement permanent indirect restorations.

11(11) Other procedures authorized by regulations adopted by the
12board.

13(c) All procedures required to be performed under direct
14supervision shall be checked and approved by the supervising
15licensed dentist prior to the patient’s dismissal from the office.

16(d) (1) A registered dental assistant in extended functions
17licensed on or after January 1, 2010, is authorized to place interim
18therapeutic restorations, defined as the removal of caries using
19hand instruments and placement of an adhesive restorative material,
20upon the order of the supervising dentist under general supervision,
21except as authorized pursuant to paragraph (3), and pursuant to
22the order, control, and full professional responsibility of a licensed
23 dentist.

24 (2) A registered dental assistant in extended function may only
25perform the functions authorized pursuant to paragraph (1) if he
26or she has completed a board-approved registered dental assistant
27in extended function education program in performing those
28functions, or if he or she has provided evidence, satisfactory to the
29board, of having completed a board-approved course in those
30functions.

31(3) The supervising licensed dentist shall be responsible for
32determining whether the functions authorized pursuant to paragraph
33(1) may be performed under general or direct supervision.

end delete
34begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 1753.55 is added to the end insertbegin insertBusiness and
35Professions Code
end insert
begin insert, to read:end insert

begin insert
36

begin insert1753.55.end insert  

(a) For the purposes of this section, the following
37definitions shall apply:

38(1) “Clinical instruction” means instruction in which students
39receive supervised experience in performing procedures in a
40clinical setting on patients. Clinical instruction shall only be
P6    1performed upon successful demonstration and evaluation of
2preclinical skills. There shall be at least one instructor for every
3six students who are simultaneously engaged in clinical instruction.

4(2) “Course” means a board-approved course preparing a
5registered dental assistant in extended functions to perform the
6duties described in subdivision (b).

7(3) “Didactic instruction” means lectures, demonstrations, and
8other instruction without active participation by students. The
9approved provider or its designee may provide didactic instruction
10through electronic media, home study materials, or live lecture
11methodology if the provider has submitted that content to the board
12for approval.

13(4) “Interim therapeutic restoration” means a direct provisional
14restoration placed to stabilize the tooth until a licensed dentist
15diagnoses the need for further definitive treatment.

16(5) “Laboratory instruction” means instruction in which
17students receive supervised experience performing procedures
18using study models, mannequins, or other simulation methods.

19(6) “Preclinical instruction” means instruction in which students
20receive supervised experience performing procedures on students,
21faculty, or staff members. There shall be at least one instructor
22for every six students who are simultaneously engaged in
23preclinical instruction.

24(7) “Program” means a board-approved registered dental
25assistant in extended functions educational program.

26(b) In addition to the duties specified in Section 1753.5, a
27registered dental assistant in extended functions licensed on or
28after January 1, 2010, is authorized to perform both of the
29following additional duties pursuant to the order, control, and full
30professional responsibility of a supervising dentist:

31(1) Choose radiographs without the supervising dentist having
32first examined the patient, following protocols established by the
33supervising dentist and, consistent with the use of as low as
34reasonably necessary radiation, for the purpose of diagnosis and
35treatment planning by the dentist. The radiographs shall be taken
36only in either of the following settings:

37(A) In a dental office setting, under the direct or general
38supervision of a dentist as determined by the dentist.

39(B) In public health settings, including, but not limited to,
40schools, head start and preschool programs, and residential
P7    1facilities and institutions, under the general supervision of a
2dentist.

3(2) Place protective restorations, which for this purpose are
4identified as interim therapeutic restorations, as defined by
5paragraph (4) of subdivision (a), that compromise the removal of
6soft material from the tooth using only hand instrumentation,
7without the use of rotary instrumentation, and subsequent
8placement of an adhesive restorative material. Local anesthesia
9shall not be necessary. The protective restorations shall be placed
10only in accordance with both of the following:

11(A) In either of the following settings:

12(i) In a dental office setting, under the direct or general
13supervision of a dentist as determined by the dentist.

14(ii) In public health settings, including, but not limited to,
15schools, head start and preschool programs, and residential
16facilities and institutions, under the general supervision of a
17dentist.

18(B) After a diagnosis and treatment plan by a dentist.

19(c) The functions described in subdivision (b) may be performed
20by a registered dental assistant in extended functions only after
21completion of a program that includes training in performing those
22functions, or after providing evidence, satisfactory to the board,
23of having completed a board-approved course in those functions.

24(1) A registered dental assistant in extended functions who has
25completed the prescribed training in the Health Workforce Pilot
26Project #172 established by the Office of Statewide Health
27Planning and Development pursuant to Article 1 (commencing
28with Section 128125) of Chapter 3 of Part 3 of Division 107 of the
29Health and Safety Code shall be deemed to have satisfied the
30requirement for completion of a course of instruction approved
31by the board.

32(2) In addition to the instructional components described in
33subdivision (d) or (e), a program shall contain both of the
34instructional components described in this paragraph:

35(A) The course shall be established at the postsecondary
36educational level.

37(B) All faculty responsible for clinical evaluation shall have
38completed a one-hour methodology course in clinical evaluation
39or have a faculty appointment at an accredited dental education
40program prior to conducting evaluations of students.

P8    1(d) A program or course to perform the duties described in
2paragraph (1) of subdivision (b) shall contain all of the additional
3instructional components described in this subdivision.

4(1) The program shall be of sufficient duration for the student
5to develop minimum competency making decisions about which
6radiographs to take to facilitate an evaluation by a dentist, but
7shall in no event be less than six hours, including at least two hours
8of didactic training, at least two hours of guided laboratory
9simulation training, and at least two hours of examination using
10simulated cases.

11(2) Didactic instruction shall consist of instruction on both of
12the following topics:

13(A) Guidelines for radiographic decisionmaking prepared by
14the American Dental Association and other professional dental
15associations.

16(B) Specific decisionmaking protocols that incorporate
17information about the patient’s health and radiographic history,
18the time span since previous radiographs were taken, the
19availability of previous radiographs, the general condition of the
20mouth including the extent of dental restorations present, and
21visible signs of abnormalities, including broken teeth, dark areas,
22and holes in teeth.

23(3) Laboratory instruction shall consist of simulated
24decisionmaking using case studies containing the elements
25 described in paragraph (2). There shall be at least one instructor
26for every 14 students who are simultaneously engaged in
27laboratory instruction.

28(4) Examinations shall consist of decisionmaking where students
29make decisions and demonstrate competency to faculty on case
30studies containing the elements described in paragraph (2).

31(e) A program or course to perform the duties described in
32paragraph (2) of subdivision (b) shall contain all of the additional
33instructional components described in this subdivision.

34(1) The program shall be of sufficient duration for the student
35to develop minimum competency in the application of protective
36restorations, including interim therapeutic restorations, but shall
37in no event be less than 16 clock hours, including at least four
38hours of didactic training, at least four hours of laboratory
39training, and at least eight hours of clinical training.

P9    1(2) Didactic instruction shall consist of instruction on all of the
2following topics:

3(A) Pulpal anatomy.

4(B) Theory of adhesive restorative materials used in the
5placement of adhesive protective restorations related to
6mechanisms of bonding to tooth structure, handling characteristics
7of the materials, preparation of the tooth prior to material
8placement, and placement techniques.

9(C) Criteria that dentists use to make decisions about placement
10of adhesive protective restorations including all of the following:

11(i) Patient factors:

12(I) The patient’s American Society of Anesthesiologists Physical
13Status Classification is Class III or less.

14(II) The patient is cooperative enough to have the restoration
15placed without the need for special protocols, including sedation
16or physical support.

17(III) The patient, or responsible party, has provided consent for
18the procedure.

19(IV) The patient reports that the tooth is asymptomatic, or if
20there is mild sensitivity to sweet, hot, or cold that the sensation
21stops within a few seconds of the stimulus being removed.

22(ii) Tooth factors:

23(I) The cavity is accessible without the need for creating access
24using a dental handpiece.

25(II) The margins of the cavity are accessible so that clean
26noncarious margins can be obtained around the entire periphery
27of the cavity with the use of hand instruments.

28(III) The depth of the lesion is more than two millimeters from
29the pulp on radiographic examination or is judged by the dentist
30to be a shallow lesion such that the treatment does not endanger
31the pulp or require the use of local anesthetic.

32(IV) The tooth is restorable and does not have other significant
33pathology.

34(D) Criteria for evaluating successful completion of adhesive
35protective restorations including all of the following:

36(i) The restorative material is not in hyperocclusion.

37(ii) There are no marginal voids.

38(iii) There is minimal excess material.

P10   1(E) Protocols for handling sensitivity, complications, or
2unsuccessful completion of adhesive protective restorations
3including situations requiring immediate referral to a dentist.

4(F) Protocols for followup of adhesive protective restorations.

5(3) Laboratory instruction shall consist of placement of adhesive
6protective restorations where students demonstrate competency
7in this technique on typodont teeth.

8(4) Clinical instruction shall consist of experiences where
9students demonstrate placement of adhesive protective restorations
10under direct supervision of faculty.

11(f) This section shall remain in effect only until January 1, 2018,
12and as of that date is repealed, unless a later enacted statute, that
13is enacted before January 1, 2018, deletes or extends that date.

end insert
14begin insert

begin insertSEC. 3.end insert  

end insert

begin insertSection 1753.55 is added to the end insertbegin insertBusiness and
15Professions Code
end insert
begin insert, to read:end insert

begin insert
16

begin insert1753.55.end insert  

(a) For the purposes of this section, “interim
17therapeutic restoration” means a direct provisional restoration
18placed to stabilize the tooth until a licensed dentist diagnoses the
19need for further definitive treatment.

20(b) In addition to the duties specified in Section 1753.5, a
21registered dental assistant in extended functions licensed on or
22after January 1, 2010, is authorized to perform both of the
23following additional duties pursuant to the order, control, and full
24professional responsibility of a supervising dentist:

25(1) Choose radiographs without the supervising dentist having
26first examined the patient, following protocols established by the
27supervising dentist and, consistent with the use of as low as
28reasonably necessary radiation, for the purpose of diagnosis and
29treatment planning by the dentist. The radiographs shall be taken
30only in either of the following settings:

31(A) In a dental office setting, under the direct or general
32supervision of a dentist as determined by the dentist.

33(B) In public health settings, including, but not limited to,
34schools, head start and preschool programs, and residential
35facilities and institutions, under the general supervision of a
36dentist.

37(2) Place protective restorations through interim therapeutic
38restorations that remove soft material from the tooth using only
39hand instrumentation, without the use of rotary instrumentation,
40and subsequent placement of an adhesive restorative material,
P11   1without the use of local anesthesia. The protective restorations
2shall only be placed subject to both of the following:

3(A) In either of the following settings:

4(i) In a dental office setting, under the direct or general
5supervision of a dentist as determined by the dentist.

6(ii) In public health settings, including, but not limited to,
7schools, head start and preschool programs, and residential
8facilities and institutions, under the general supervision of a
9dentist.

10(B) After a diagnosis and treatment plan by a dentist.

11(c) This section shall become operative on January 1, 2018.

end insert
12

begin deleteSEC. 3.end delete
13begin insertSEC. 4.end insert  

Section 1753.6 of the Business and Professions Code
14 is amended to read:

15

1753.6.  

(a) Each person who holds a license as a registered
16dental assistant in extended functions on the operative date of this
17section may only perform those procedures that a registered dental
18assistant is allowed to perform as specified in and limited by
19Section 1752.4, and the procedures specified in paragraphs (1) to
20(6), inclusive, until he or she provides evidence of having
21completed a board-approved course in the additional procedures
22specified in paragraphs (1), (2), (5), and (7) to (11), inclusive, of
23subdivision (b)begin delete, and paragraph (1) of subdivision (d),end delete of Section
241753.5, and an examination as specified in Section 1753.4:

25(1) Cord retraction of gingiva for impression procedures.

26(2) Take final impressions for permanent indirect restorations.

27(3) Formulate indirect patterns for endodontic post and core
28castings.

29(4) Fit trial endodontic filling points.

30(5) Apply pit and fissure sealants.

31(6) Remove excess cement from subgingival tooth surfaces with
32a hand instrument.

begin delete

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

end delete
begin insert

34(b) This section shall remain in effect only until January 1, 2018,
35and as of that date is repealed, unless a later enacted statute, that
36is enacted before January 1, 2018, deletes or extends that date.

end insert
37begin insert

begin insertSEC. end insertbegin insert5.end insert  

end insert

begin insertSection 1753.6 is added to the end insertbegin insertBusiness and Professions
38Code
end insert
begin insert, to read:end insert

begin insert
39

begin insert1753.6.end insert  

(a) Each person who holds a license as a registered
40dental assistant in extended functions on the operative date of this
P12   1section may only perform those procedures that a registered dental
2assistant is allowed to perform as specified in and limited by
3Section 1752.4, and the procedures specified in paragraphs (1) to
4(6), inclusive, until he or she provides evidence of having completed
5a board-approved course in the additional procedures specified
6in paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision
7(b) of Section 1753.5, procedures specified in Section 1753.55,
8and an examination as specified in Section 1753.4:

9(1) Cord retraction of gingiva for impression procedures.

10(2) Take final impressions for permanent indirect restorations.

11(3) Formulate indirect patterns for endodontic post and core
12castings.

13(4) Fit trial endodontic filling points.

14(5) Apply pit and fissure sealants.

15(6) Remove excess cement from subgingival tooth surfaces with
16a hand instrument.

17(b) This section shall become operative on January 1, 2018.

end insert
18

begin deleteSEC. 4.end delete
19begin insertSEC. 6.end insert  

Section 1910 of the Business and Professions Code is
20amended to read:

21

1910.  

A registered dental hygienist is authorized to perform
22the following procedures under general supervision:

23(a) Preventive and therapeutic interventions, including oral
24prophylaxis, scaling, and root planing.

25(b) Application of topical, therapeutic, and subgingival agents
26used for the control of caries and periodontal disease.

27(c) The taking of impressions for bleaching trays and application
28and activation of agents with nonlaser, light-curing devices.

29(d) The taking of impressions for bleaching trays and placements
30of in-office, tooth-whitening devices.

31(e) After submitting to the committee evidence of satisfactory
32completion of a course of instruction approved by the committee,
33the following:

34(1) Determine which radiographs to perform.

35(2) Place interim therapeutic restorations, defined as the removal
36of caries using hand instruments and placement of an adhesive
37restorative material, upon the order of a licensed dentist.

begin delete
38

SEC. 5.  

Section 14132.726 is added to the Welfare and
39Institutions Code
, to read:

P13   1

14132.726.  

(a) To the extent that federal financial participation
2is available, face-to-face contact between a health care provider
3and a patient shall not be required under the Medi-Cal program
4for teledentistry by store and forward. Services appropriately
5provided through the store and forward process are subject to
6billing and reimbursement policies developed by the department.

7(b) A patient receiving teledentistry by store and forward shall
8be notified of the right to receive interactive communication with
9the distant dentist, and shall receive an interactive communication
10with the distant dentist, upon request. If requested, communication
11with the distant dentist may occur either at the time of the
12consultation, or within 30 days of the patient’s notification of the
13results of the consultation.

14(c) Dentist participation in services provided at an intermittent
15clinic, as defined in Section 1206 of the Health and Safety Code,
16through the use of telehealth, as defined in Section 2290.5 of the
17Business and Professions Code, shall be considered a billable
18encounter under Medi-Cal.

19(d) Notwithstanding Chapter 3.5 (commencing with Section
2011340) of Part 1 of Division 3 of Title 2 of the Government Code,
21the department may implement, interpret, and make specific this
22section by means of all-county letters, provider bulletins, and
23similar instructions.

24(e) On or before January 1, 2017, the department shall report
25to the Legislature the number and type of services provided, and
26the payments made related to the application of store and forward
27teledentistry as provided, under this section as a Medi-Cal benefit.

28(f) For purposes of this section, the following definitions apply:

29(1) “Asynchronous store and forward” means the transmission
30of a patient’s dental information from an originating site to the
31health care provider at a distant site without the presence of the
32patient.

33(2) “Distant site” means a site where a health care provider who
34provides health care services is located while providing these
35services via a telecommunications system.

36(3) “Health care provider” means a person who is licensed under
37Chapter 4 (commencing with Section 1600) of Division 2 of the
38Business and Professions Code.

39(4) “Originating site” means a site where a patient is located at
40the time health care services are provided via a telecommunications
P14   1system or where the asynchronous store and forward service
2originates.

3(5) “Synchronous interaction” means a real-time interaction
4between a patient and a health care provider located at a distant
5site.

6(6) “Teledentistry” means the mode of delivering dental health
7care services and public dental health via information and
8communication technologies to facilitate the diagnosis,
9consultation, treatment, education, care management, and
10self-management of a patient’s dental health care while the patient
11is at the originating site and the dental health care provider is at a
12distant site. Teledentistry includes synchronous interactions and
13asynchronous store and forward transfers.

14(7) “Teledentistry by store and forward” means an asynchronous
15transmission of dental information to be reviewed at a later time
16by a licensed dentist at a distant site, where the dentist at the distant
17site reviews the dental information without the patient being present
18in real time.

end delete
19begin insert

begin insertSEC. 7.end insert  

end insert

begin insertSection 1910.5 is added to the end insertbegin insertBusiness and Professions
20Code
end insert
begin insert, to read:end insert

begin insert
21

begin insert1910.5.end insert  

(a) For the purposes of this section, the following
22definitions shall apply:

23(1) “Clinical instruction” means instruction in which students
24receive supervised experience in performing procedures in a
25clinical setting on patients. Clinical instruction shall only be
26performed upon successful demonstration and evaluation of
27preclinical skills. There shall be at least one instructor for every
28six students who are simultaneously engaged in clinical instruction.

29(2) “Course” means a committee-approved course preparing
30registered dental hygienist to perform the duties described in
31subdivision (b).

32(3) “Didactic instruction” means lectures, demonstrations, and
33other instruction without active participation by students. The
34approved provider or its designee may provide didactic instruction
35through electronic media, home study materials, or live lecture
36methodology if the provider has submitted that content to the
37committee for approval.

38(4) “Interim therapeutic restoration” means a direct provisional
39restoration placed to stabilize the tooth until a licensed dentist
40diagnoses the need for further definitive treatment.

P15   1(5) “Laboratory instruction” means instruction in which
2students receive supervised experience performing procedures
3using study models, mannequins, or other simulation methods.

4(6) “Preclinical instruction” means instruction in which students
5receive supervised experience performing procedures on students,
6faculty, or staff members. There shall be at least one instructor
7for every six students who are simultaneously engaged in
8preclinical instruction.

9(7) “Program” means a committee-approved registered dental
10hygienist educational program.

11(b) A registered dental hygienist may perform both of the
12following duties:

13(1) Choose radiographs without the supervising dentist having
14first examined the patient, following protocols established by the
15supervising dentist and, consistent with the use of as low as
16reasonably necessary radiation, for the purpose of diagnosis and
17treatment planning by the dentist. The radiographs shall be taken
18only in either of the following settings:

19(A) In a dental office setting, under the general supervision of
20a dentist.

21(B) In a public health setting, including, but not limited to,
22schools, head start and preschool programs, and residential
23facilities and institutions, under the general supervision of a
24dentist.

25(2) Place protective restorations, which for this purpose are
26identified as interim therapeutic restorations, as defined by
27paragraph (4) of subdivision (a), that compromise the removal of
28soft material from the tooth using only hand instrumentation,
29without the use of rotary instrumentation, and subsequent
30placement of an adhesive restorative material. Local anesthesia
31shall not be necessary. The protective restorations shall be placed
32only in accordance with both of the following:

33(A) In either of the following settings:

34(i) In a dental office setting, under the general supervision of a
35dentist.

36(ii) In a public health setting, including, but not limited to,
37schools, head start and preschool programs, and residential
38facilities and institutions, under the general supervision of a
39dentist.

40(B) After a diagnosis and treatment plan by a dentist.

P16   1(c) The functions described in subdivision (b) may be performed
2by a registered dental hygienist only after completion of a program
3that includes training in performing those functions, or after
4providing evidence, satisfactory to the committee, of having
5completed a committee-approved course in those functions.

6(1) A registered dental hygienist who has completed the
7prescribed training in the Health Workforce Pilot Project #172
8established by the Office of Statewide Health Planning and
9Development pursuant to Article 1 (commencing with Section
10128125) of Chapter 3 of Part 3 of Division 107 of the Health and
11Safety Code shall be deemed to have satisfied the requirement for
12completion of a course of instruction approved by the committee.

13(2) In addition to the instructional components described in
14subdivision (d) or (e), a program shall contain both of the
15instructional components described in this paragraph:

16(A) The course shall be established at the postsecondary
17educational level.

18(B) All faculty responsible for clinical evaluation shall have
19completed a one-hour methodology course in clinical evaluation
20or have a faculty appointment at an accredited dental education
21program prior to conducting evaluations of students.

22(d) A program or course to perform the duties described in
23paragraph (1) of subdivision (b) shall contain all of the additional
24instructional components described in this subdivision.

25(1) The program shall be of sufficient duration for the student
26to develop minimum competency making decisions about which
27radiographs to take to facilitate an evaluation by a dentist, but
28shall in no event be less than six hours, including at least two hours
29of didactic training, at least two hours of guided laboratory
30simulation training, and at least two hours of examination using
31simulated cases.

32(2) Didactic instruction shall consist of instruction on both of
33the following topics:

34(A) Guidelines for radiographic decision making prepared by
35the American Dental Association and other professional dental
36associations.

37(B) Specific decisionmaking protocols that incorporate
38information about the patient’s health and radiographic history,
39the time span since previous radiographs were taken, the
40availability of previous radiographs, the general condition of the
P17   1mouth including the extent of dental restorations present, and
2visible signs of abnormalities, including broken teeth, dark areas,
3and holes in teeth.

4(3) Laboratory instruction shall consist of simulated decision
5making using case studies containing the elements described in
6paragraph (2). There shall be at least one instructor for every 14
7students who are simultaneously engaged in laboratory instruction.

8(4) Examination shall consist of decisionmaking where students
9make decisions and demonstrate competency to faculty on case
10studies containing the elements described in paragraph (2).

11(e) A program or course to perform the duties described in
12paragraph (2) of subdivision (b) shall contain all of the additional
13instructional components described in this subdivision.

14(1) The program shall be of sufficient duration for the student
15to develop minimum competency in the application of protective
16restorations, including interim therapeutic restorations, but shall
17in no event be less than 16 clock hours, including at least four
18hours of didactic training, at least four hours of laboratory
19training, and at least eight hours of clinical training.

20(2) Didactic instruction shall consist of instruction on all of the
21following topics:

22(A) Pulpal anatomy.

23(B) Theory of adhesive restorative materials used in the
24placement of adhesive protective restorations related to
25mechanisms of bonding to tooth structure, handling characteristics
26of the materials, preparation of the tooth prior to material
27placement, and placement techniques.

28(C) Criteria that dentists use to make decisions about placement
29of adhesive protective restorations including all of the following:

30(i) Patient factors:

31(I) The patient’s American Society of Anesthesiologists Physical
32Status Classification is Class III or less.

33(II) The patient is cooperative enough to have the restoration
34placed without the need for special protocols, including sedation
35or physical support.

36(III) The patient, or responsible party, has provided consent for
37the procedure.

38(IV) The patient reports that the tooth is asymptomatic, or if
39there is mild sensitivity to sweet, hot, or cold that the sensation
40stops within a few seconds of the stimulus being removed.

P18   1(ii) Tooth factors:

2(I) The cavity is accessible without the need for creating access
3using a dental handpiece.

4(II) The margins of the cavity are accessible so that clean
5noncarious margins can be obtained around the entire periphery
6of the cavity with the use of hand instruments.

7(III) The depth of the lesion is more than two millimeters from
8the pulp on radiographic examination or is judged by the dentist
9to be a shallow lesion such that the treatment does not endanger
10the pulp or require the use of local anesthetic.

11(IV) The tooth is restorable and does not have other significant
12pathology.

13(D) Criteria for evaluating successful completion of adhesive
14protective restorations including all of the following:

15(i) The restorative material is not in hyperocclusion.

16(ii) There are no marginal voids.

17(iii) There is minimal excess material.

18(E) Protocols for handling sensitivity, complications, or
19unsuccessful completion of adhesive protective restorations
20including situations requiring immediate referral to a dentist.

21(F) Protocols for followup of adhesive protective restorations.

22(3) Laboratory instruction shall consist of placement of adhesive
23protective restorations where students demonstrate competency
24in this technique on typodont teeth.

25(4) Clinical instruction shall consist of experiences where
26students demonstrate competency in placement of adhesive
27protective restorations under direct supervision of faculty.

28(f) This section shall remain in effect only until January 1, 2018,
29and as of that date is repealed, unless a later enacted statute, that
30is enacted before January 1, 2018, deletes or extends that date.

end insert
31begin insert

begin insertSEC. 8.end insert  

end insert

begin insertSection 1910.5 is added to the end insertbegin insertBusiness and Professions
32Code
end insert
begin insert, to read:end insert

begin insert
33

begin insert1910.5.end insert  

(a) For the purposes of this section, “interim
34therapeutic restoration” means a direct provisional restoration
35placed to stabilize the tooth until a licensed dentist diagnoses the
36need for further definitive treatment.

37(b) A registered dental hygienist may perform both of the
38following duties:

39(1) Choose radiographs without the supervising dentist having
40first examined the patient, following protocols established by the
P19   1supervising dentist and, consistent with the use of as low as
2reasonably necessary radiation, for the purpose of diagnosis and
3treatment planning by the dentist. The radiographs shall be taken
4only in either of the following settings:

5(A) In a dental office setting, under the general supervision of
6a dentist.

7(B) In a public health setting, including, but not limited to,
8schools, head start and preschool programs, and residential
9facilities and institutions, under the general supervision of a
10dentist.

11(2) Place protective restorations, which for this purpose are
12identified as interim therapeutic restorations, as defined by
13subdivision (a), that comprise the removal of soft material from
14the tooth using only hand instrumentation, without the use of rotary
15instrumentation, and subsequent placement of an adhesive
16restorative material. Local anesthesia shall not be necessary. The
17protective restorations shall be placed only in accordance with
18both of the following:

19(A) In either of the following settings:

20(i) In a dental office setting, under the general supervision of a
21dentist.

22(ii) In a public health setting, including, but not limited to,
23schools, head start and preschool programs, and residential
24facilities and institutions, under the general supervision of a
25dentist.

26(B) After a diagnosis and treatment plan by a dentist.

27(c) The functions described in subdivision (b) may be performed
28by a registered dental hygienist only after completion of a program
29that includes training in performing those functions, or after
30providing evidence, satisfactory to the committee, of having
31completed a committee-approved course in those functions.

32(d) This section shall become operative on January 1, 2018.

end insert
33begin insert

begin insertSEC. 9.end insert  

end insert

begin insertSection 1926 of the end insertbegin insertBusiness and Professions Codeend insertbegin insert is
34amended to read:end insert

35

1926.  

A registered dental hygienist in alternative practice may
36perform the duties authorized pursuant to subdivision (a) of Section
371907, subdivision (a) of Section 1908,begin delete andend delete subdivisions (a) and
38(b) of Section 1910begin insert, and Section 1926.05end insert in the following settings:

39(a) Residences of the homebound.

40(b) Schools.

P20   1(c) Residential facilities and other institutions.

2(d) Dental health professional shortage areas, as certified by the
3Office of Statewide Health Planning and Development in
4accordance with existing office guidelines.

5begin insert

begin insertSEC. 10.end insert  

end insert

begin insertSection 1926.05 is added to the end insertbegin insertBusiness and
6Professions Code
end insert
begin insert, to read:end insert

begin insert
7

begin insert1926.05.end insert  

(a) For the purposes of this section, the following
8definitions shall apply:

9(1) “Clinical instruction” means instruction in which students
10receive supervised experience in performing procedures in a
11clinical setting on patients. Clinical instruction shall only be
12performed upon successful demonstration and evaluation of
13preclinical skills. There shall be at least one instructor for every
14six students who are simultaneously engaged in clinical instruction.

15(2) “Course” means a committee-approved course preparing
16registered dental hygienist in alternative practice to perform the
17duties described in subdivision (b).

18(3) “Didactic instruction” means lectures, demonstrations, and
19other instruction without active participation by students. The
20approved provider or its designee may provide didactic instruction
21through electronic media, home study materials, or live lecture
22methodology if the provider has submitted that content to the
23committee for approval.

24(4) “Interim therapeutic restoration” means a direct provisional
25restoration placed to stabilize the tooth until a licensed dentist
26diagnoses the need for further definitive treatment.

27(5) “Laboratory instruction” means instruction in which
28students receive supervised experience performing procedures
29using study models, mannequins, or other simulation methods.

30(6) “Preclinical instruction” means instruction in which students
31receive supervised experience performing procedures on students,
32faculty, or staff members. There shall be at least one instructor
33for every six students who are simultaneously engaged in
34preclinical instruction.

35(7) “Program” means a committee-approved registered dental
36hygienist in alternative practice educational program.

37(b) A registered dental hygienist in alternative practice may
38perform both of the following duties:

39(1) Choose radiographs without the supervising dentist having
40first examined the patient, following protocols established by the
P21   1supervising dentist and, consistent with the use of as low as
2reasonably necessary radiation, for the purpose of diagnosis and
3treatment planning by the dentist. The radiographs shall be taken
4only in either of the following settings:

5(A) In a dental office setting, under the general supervision of
6a dentist.

7(B) In a public health setting, including, but not limited to,
8schools, head start and preschool programs, and residential
9facilities and institutions, under the general supervision of a
10dentist.

11(2) Place protective restorations, which for this purpose are
12identified as interim therapeutic restorations, as defined by
13paragraph (4) of subdivision (a), that compromise the removal of
14soft material from the tooth using only hand instrumentation,
15without the use of rotary instrumentation, and subsequent
16placement of an adhesive restorative material. Local anesthesia
17shall not be necessary. The protective restorations shall be placed
18only in accordance with both of the following:

19(A) In either of the following settings:

20(i) In a dental office setting, under the general supervision of a
21dentist.

22(ii) In a public health setting, including, but not limited to,
23schools, head start and preschool programs, and residential
24facilities and institutions, under the general supervision of a
25dentist.

26(B) After a diagnosis and treatment plan by a dentist.

27(c) The functions described in subdivision (b) may be performed
28by a registered dental hygienist in alternative practice only after
29completion of a course or program that includes training in
30performing those functions, or after providing evidence,
31satisfactory to the committee, of having completed a
32committee-approved course in those functions.

33(1) A registered dental hygienist in alternative practice who
34has completed the prescribed training in the Health Workforce
35Pilot Project #172 established by the Office of Statewide Health
36Planning and Development pursuant to Article 1 (commencing
37with Section 128125) of Chapter 3 of Part 3 of Division 107 of the
38Health and Safety Code shall be deemed to have satisfied the
39requirement for completion of a course of instruction approved
40by the committee.

P22   1(2) In addition to the instructional components described in
2subdivision (d) or (e), a program shall contain both of the
3instructional components described in this paragraph:

4(A) The course shall be established at the postsecondary
5educational level.

6(B) All faculty responsible for clinical evaluation shall have
7completed a one-hour methodology course in clinical evaluation
8or have a faculty appointment at an accredited dental education
9program prior to conducting evaluations of students.

10(d) A program or course to perform the duties described in
11paragraph (1) of subdivision (b) shall contain all of the additional
12instructional components described in this subdivision.

13(1) The program shall be of sufficient duration for the student
14to develop minimum competency making decisions about which
15radiographs to take to facilitate an evaluation by a dentist, but
16shall in no event be less than six hours, including at least two hours
17of didactic training, at least two hours of guided laboratory
18simulation training, and at least two hours of examination using
19simulated cases.

20(2) Didactic instruction shall consist of instruction on both of
21the following topics:

22(A) Guidelines for radiographic decision making prepared by
23the American Dental Association and other professional dental
24associations.

25(B) Specific decisionmaking protocols that incorporate
26information about the patient’s health and radiographic history,
27the time span since previous radiographs were taken, the
28availability of previous radiographs, the general condition of the
29mouth including the extent of dental restorations present, and
30visible signs of abnormalities, including broken teeth, dark areas,
31and holes in teeth.

32(3) Laboratory instruction shall consist of simulated decision
33making using case studies containing the elements described in
34paragraph (2). There shall be at least one instructor for every 14
35students who are simultaneously engaged in laboratory instruction.

36(4) Examination shall consist of decisionmaking where students
37make decisions and demonstrate competency to faculty on case
38studies containing the elements described in paragraph (2).

P23   1(e) A program or course to perform the duties described in
2paragraph (2) of subdivision (b) shall contain all of the additional
3instructional components described in this subdivision.

4(1) The program shall be of sufficient duration for the student
5to develop minimum competency in the application of protective
6restorations, including interim therapeutic restorations, but shall
7in no event be less than 16 clock hours, including at least four
8hours of didactic training, at least four hours of laboratory
9training, and at least eight hours of clinical training.

10(2) Didactic instruction shall consist of instruction on all of the
11following topics:

12(A) Pulpal anatomy.

13(B) Theory of adhesive restorative materials used in the
14placement of adhesive protective restorations related to
15mechanisms of bonding to tooth structure, handling characteristics
16of the materials, preparation of the tooth prior to material
17placement, and placement techniques.

18(C) Criteria that dentists use to make decisions about placement
19of adhesive protective restorations including all of the following:

20(i) Patient factors:

21(I) The patient’s American Society of Anesthesiologists Physical
22Status Classification is Class III or less.

23(II) The patient is cooperative enough to have the restoration
24placed without the need for special protocols, including sedation
25or physical support.

26(III) The patient, or responsible party, has provided consent for
27the procedure.

28(IV) The patient reports that the tooth is asymptomatic, or if
29there is mild sensitivity to sweet, hot, or cold that the sensation
30stops within a few seconds of the stimulus being removed.

31(ii) Tooth factors:

32(I) The cavity is accessible without the need for creating access
33using a dental handpiece.

34(II) The margins of the cavity are accessible so that clean
35noncarious margins can be obtained around the entire periphery
36of the cavity with the use of hand instruments.

37(III) The depth of the lesion is more than two millimeters from
38the pulp on radiographic examination or is judged by the dentist
39to be a shallow lesion such that the treatment does not endanger
40the pulp or require the use of local anesthetic.

P24   1(IV) The tooth is restorable and does not have other significant
2pathology.

3(D) Criteria for evaluating successful completion of adhesive
4protective restorations including all of the following:

5(i) The restorative material is not in hyperocclusion.

6(ii) There are no marginal voids.

7(iii) There is minimal excess material.

8(E) Protocols for handling sensitivity, complications, or
9unsuccessful completion of adhesive protective restorations
10including situations requiring immediate referral to a dentist.

11(F) Protocols for followup of adhesive protective restorations.

12(3) Laboratory instruction shall consist of placement of adhesive
13protective restorations where students demonstrate competency
14in this technique on typodont teeth.

15(4) Clinical instruction shall consist of experiences where
16students demonstrate competency in placement of adhesive
17protective restorations under direct supervision of faculty.

18(f) This section shall remain in effect only until January 1, 2018,
19and as of that date is repealed, unless a later enacted statute, that
20is enacted before January 1, 2018, deletes or extends that date.

end insert
21begin insert

begin insertSEC. 11.end insert  

end insert

begin insertSection 1926.05 is added to the end insertbegin insertBusiness and
22Professions Code
end insert
begin insert, to read:end insert

begin insert
23

begin insert1926.05.end insert  

(a) For the purposes of this section, “interim
24therapeutic restoration” means a direct provisional restoration
25placed to stabilize the tooth until a licensed dentist diagnoses the
26need for further definitive treatment.

27(b) A registered dental hygienist in alternative practice may
28perform both of the following duties:

29(1) Choose radiographs without the supervising dentist having
30first examined the patient, following protocols established by the
31supervising dentist and, consistent with the use of as low as
32reasonably necessary radiation, for the purpose of diagnosis and
33treatment planning by the dentist. The radiographs shall be taken
34only in either of the following settings:

35(A) In a dental office setting, under the general supervision of
36a dentist.

37(B) In a public health setting, including, but not limited to,
38schools, head start and preschool programs, and residential
39facilities and institutions, under the general supervision of a
40dentist.

P25   1(2) Place protective restorations, which for this purpose are
2identified as interim therapeutic restorations, as defined by
3subdivision (a), that compromise the removal of soft material from
4the tooth using only hand instrumentation, without the use of rotary
5instrumentation, and subsequent placement of an adhesive
6restorative material. Local anesthesia shall not be necessary. The
7protective restorations shall be placed only in accordance with
8both of the following:

9(A) In either of the following settings:

10(i) In a dental office setting, under the general supervision of a
11dentist.

12(ii) In a public health setting, including, but not limited to,
13schools, head start and preschool programs, and residential
14facilities and institutions, under the general supervision of a
15dentist.

16(B) After a diagnosis and treatment plan by a dentist.

17(c) The functions described in subdivision (b) may be performed
18by a registered dental hygienist in alternative practice only after
19completion of a course or program that includes training in
20performing those functions, or after providing evidence,
21satisfactory to the committee, of having completed a
22committee-approved course in those functions.

23(d) This section shall become operative on January 1, 2018.

end insert
24begin insert

begin insertSEC. 12.end insert  

end insert

begin insertSection 14132.725 of the end insertbegin insertWelfare and Institutions
25Code
end insert
begin insert is amended to read:end insert

26

14132.725.  

(a) begin deleteCommencing July 1, 2006, to end deletebegin insertTo end insertthe extent
27that federal financial participation is available, face-to-face contact
28between a health care provider and a patientbegin delete shallend deletebegin insert isend insert notbegin delete beend delete required
29under the Medi-Cal program for teleophthalmologybegin delete andend deletebegin insert,end insert
30 teledermatologybegin insert, and teledentistryend insert by store and forward. Services
31appropriately provided through the store and forward process are
32subject to billing and reimbursement policies developed by the
33department.

34(b) For purposes of this section, “teleophthalmologybegin delete andend deletebegin insert,end insert
35 teledermatologybegin insert, and teledentistryend insert by store and forward” means
36an asynchronous transmission of medical begin insertor dental end insertinformation to
37be reviewed at a later time by a physician at a distant site who is
38trained in ophthalmology or dermatology or, for teleophthalmology,
39by an optometrist who is licensed pursuant to Chapter 7
40(commencing with Section 3000) of Division 2 of the Business
P26   1and Professions Code, begin insertor a dentist, end insertwhere the physicianbegin delete orend deletebegin insert,end insert
2 optometristbegin insert, or dentistend insert at the distant site reviews the medical begin insertor
3dental end insert
information without the patient being present in real time.
4A patient receiving teleophthalmologybegin delete orend deletebegin insert,end insert teledermatologybegin insert, or
5teledentistryend insert
by store and forward shall be notified of the right to
6receive interactive communication with the distant specialist
7physicianbegin delete orend deletebegin insert,end insert optometrist, begin insertor dentist end insertand shall receive an interactive
8communication with the distant specialist physicianbegin delete orend deletebegin insert,end insert optometrist,
9begin insertor dentist, end insertupon request. If requested, communication with the
10distant specialist physicianbegin delete orend deletebegin insert,end insert optometristbegin insert, or dentistend insert may occur
11either at the time of the consultation, or within 30 days of the
12patient’s notification of the results of the consultation. If the
13reviewing optometrist identifies a disease or condition requiring
14consultation or referral pursuant to Section 3041 of the Business
15and Professions Code, that consultation or referral shall be with
16an ophthalmologist or other appropriate physician and surgeon, as
17required.

18(c) Notwithstanding Chapter 3.5 (commencing with Section
1911340) of Part 1 of Division 3 of Title 2 of the Government Code,
20the department may implement, interpret, and make specific this
21section by means of all-county letters, provider bulletins, and
22similar instructions.

23(d) On or before January 1, 2008, the department shall report
24to the Legislature the number and type of services provided, and
25the payments made related to the application of store and forward
26telehealth as provided, under this section as a Medi-Cal benefit.



O

    96