Amended in Senate May 21, 2014

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 Bill No. 1174

Introduced by Assembly Members Bocanegra and Logue

February 22, 2013

An act to amend Sections begin delete 1752.4, 1910, end delete begin insert 1684.5 end insert and 1926 of, begin delete to amend, repeal, and add Section 1753.6 of, end delete and to add, repeal, and add Sections 1753.55, 1910.5, and 1926.05 of, the Business and Professions Code, begin insert and to add and repeal Section 128196 of the Health and Safety Code, end insert and to amend Section 14132.725 of the Welfare and Institutions Code, relating to oral health.

LEGISLATIVE COUNSEL’S DIGEST

AB 1174, as amended, Bocanegra. Dental begin delete professionals: teledentistry under Medi-Cal. end delete begin insert professionals. end insert

(1)  begin delete Existing end delete begin insert Under existing end insert law, the Dental Practice Act, begin delete establishes end delete the Dental Board of California begin insert licenses and regulates dentists end insert . 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 begin insert , and authorizes a dentist to require or permit one of those professionals, referred to as a dental auxiliary, to perform specified duties, including exposing emergency radiographs upon the direction of the dentist, prior to the dentist examining the patient end insert .

This bill would begin delete authorize a registered dental assistant who has completed a specified educational program to determine which radiographs to perform. The bill would authorize a end delete begin insert add to those specified duties determining and performing radiographs, as specified, make a dentist responsible to provide a patient or the patient’s representative written notice including specified contact information and disclosing that the care was provided at the direction of that authorizing dentist, and would prohibit a dentist from concurrently supervising more than 5 dental auxiliaries, as specified. The bill would authorize specified end insert registered dental begin delete assistant end delete begin insert assistants end insert in extended begin delete functions licensed on or after January 1, 2010, a end delete begin insert functions, end insert registered dental begin delete hygienist, end delete begin insert hygienists, end insert and begin delete a end delete registered dental begin delete hygienist end delete begin insert hygienists end insert in alternative practice to begin delete choose end delete begin insert determine which end insert radiographs begin insert to perform end insert and begin insert to end insert place protective restorations, as specified. begin insert The bill would require the board to promulgate related regulations, and would also require the committee to review proposed regulations and submit any recommended changes to the board for review to establish a consensus. 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.

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.

begin insert

(3) Existing law authorizes the Office of Statewide Health Planning and Development to approve Health Workforce Pilot Projects (HWPP), as defined. The office has approved operation HWPP 172, relating to dental workforce, through December 15, 2014.

end insert begin insert

This bill would extend the operation of HWPP through January 1, 2016. The bill would also delete redundant provisions.

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:

begin delete

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 postextraction 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.

end delete

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 1684.5 of the end insert begin insert Business and Professions
Code end insert begin insert is amended to read: end insert

1684.5.  

(a) In addition to other acts constituting unprofessional
conduct under this chapter, it is unprofessional conduct for any
dentist to perform or allow to be performed any treatment on a
patient who is not a patient of record of that dentist. A dentist may,
however, after conducting a preliminary oral examination, require
or permit any dental auxiliary to perform procedures necessary for
diagnostic purposes, provided that the procedures are permitted
under the auxiliary’s authorized scope of practice. Additionally,
a dentist may require or permit a dental auxiliary to perform all of
the following duties prior to any examination of the patient by the
dentist, provided that the duties are authorized for the particular
classification of dental auxiliary pursuant to Article 7 (commencing
with Section 1740):

(1)  begin delete Expose end delete begin insert Determine and perform end insert emergency radiographs upon
direction of the dentist.

begin insert

(2) Determine and perform radiographs for the specific purpose
of aiding a dentist in completing a comprehensive diagnosis and
treatment plan for a patient pursuant to Sections 1753.55, 1910.5,
and 1926.05.

end insert begin delete

(2)

end delete

begin insert (3) end insert  Perform extra-oral duties or functions specified by the
dentist.

begin delete

(3)

end delete

begin insert (4) end insert  Perform mouth-mirror inspections of the oral cavity, to
include charting of obvious lesions, malocclusions, existing
restorations, and missing teeth.

(b) For purposes of this section, “patient of record” refers to a
patient who has been examined, has had a medical and dental
history completed and evaluated, and has had oral conditions
diagnosed and a written plan developed by the licensed dentist.

begin insert

(c) For purposes of this section, if dental treatment is provided
to a patient by a dental auxiliary pursuant to the diagnosis and
treatment plan authorized by a supervising dentist, the supervising
dentist shall ensure that the patient or the patient’s representative
is notified in writing of the supervising dentist’s name, practice
location address, telephone number, and email address, and that
the care was provided at the direction of the dentist.

end insert begin insert

(d) A dentist shall not concurrently supervise more than five
dental auxiliaries providing services pursuant to Sections 1753.55,
1910.5, and 1926.05.

end insert begin delete

(c)

end delete

begin insert (e) end insert  This section shall not apply to dentists providing
examinations on a temporary basis outside of a dental office in
settings including, but not limited to, health fairs and school
screenings.

begin delete

(d)

end delete

begin insert (f) end insert  This section shall not apply to fluoride mouth rinse or
supplement programs administered in a school or preschool setting.

SEC. 2.  

Section 1753.55 is added to the Business and
Professions Code, to read:

begin delete

1753.55.  

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

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

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

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

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

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

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

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

(b)

end delete

begin insert

begin insert 1753.55. end insert   

end insert

begin insert (a) end insert  In addition to the duties specified in begin delete Section end delete
begin insert Sections end insert 1753.5 begin insert and 1753.6 end insert , a registered dental assistant in
extended functions licensed on or after January 1, 2010, begin insert or having
completed the educational requirements to perform the duties
authorized by Section 1753.5, end insert is authorized to perform both of the
following additional duties pursuant to the order, control, and full
professional responsibility of a supervising dentist:

begin delete

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

end delete begin insert

(1) Determine which radiographs to perform on a patient who
has not received an initial examination by the supervising dentist
for the specific purpose of the dentist making a diagnosis and
treatment plan for the patient. In these circumstances, the dental
assistant in extended functions shall follow protocols established
by the supervising dentist. This paragraph only applies in the
following settings:

end insert

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

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

(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, begin delete as end delete begin insert and end insert defined begin delete by
paragraph (4) of subdivision (a), that compromise end delete begin insert as a direct
provisional restoration placed to stabilize the tooth until a licensed
dentist diagnoses the need for further definitive treatment. An
interim therapeutic restoration consists of end insert the removal of soft
material from the tooth using only hand instrumentation, without
the use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary begin insert for interim therapeutic restoration placement end insert . begin delete The
protective restorations end delete begin insert Interim therapeutic restorations end insert shall be
placed only in accordance with both of the following:

(A) In either of the following settings:

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

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

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

begin delete

(c)

end delete

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

begin insert

(1) No later than January 1, 2018, the board shall promulgate
regulations establishing requirements for courses of instruction
for the procedures authorized to be performed by a registered
dental assistant in extended functions pursuant to this section.

end insert begin insert

(2) Prior to January 1, 2018, the board shall use the
competency-based training protocols established by Health
Workforce Pilot Project (HWPP) No. 172 through the Office of
Statewide Health Planning and Development.

end insert begin delete

(1)

end delete

begin insert (3) end insert  A registered dental assistant in extended functions who has
completed the prescribed training in the Health Workforce Pilot
Project begin delete #172 end delete begin insert No. 172 end insert established by the Office of Statewide Health
Planning and Development pursuant to Article 1 (commencing
with Section 128125) of Chapter 3 of Part 3 of Division 107 of
the Health and Safety Code shall be deemed to have satisfied the
requirement for completion of a course of instruction approved by
the board.

begin delete

(2)

end delete

begin insert (4) end insert  In addition to the instructional components described in
begin delete subdivision (d) or (e), end delete begin insert this subdivision, end insert a program shall contain
both of the instructional components described in this paragraph:

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

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

begin delete

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

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

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

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

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

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

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

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

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

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

(A) Pulpal anatomy.

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

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

(i) Patient factors:

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

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

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

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

(ii) Tooth factors:

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

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

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

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

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

(i) The restorative material is not in hyperocclusion.

(ii) There are no marginal voids.

(iii) There is minimal excess material.

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

(F) Protocols for followup of adhesive protective restorations.

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

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

(f)

end delete

begin insert (c) end insert  This section shall remain in effect only until January 1, 2018,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2018, deletes or extends that date.

SEC. 3.  

Section 1753.55 is added to the Business and
Professions Code, to read:

begin delete

1753.55.  

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

(b)

end delete

begin insert

begin insert 1753.55. end insert   

end insert

begin insert (a) end insert  In addition to the duties specified in Section
1753.5, a registered dental assistant in extended functions licensed
on or after January 1, 2010, begin insert or having completed the educational
requirements to perform the duties authorized by Section 1753.5, end insert
is authorized to perform both of the following additional duties
pursuant to the order, control, and full professional responsibility
of a supervising dentist:

begin delete

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

end delete begin insert

(1) Determine which radiographs to perform on a patient who
has not received an initial examination by the supervising dentist
for the specific purpose of the dentist making a diagnosis and
treatment plan for the patient. In these circumstances, the dental
assistant in extended functions shall follow protocols established
by the supervising dentist. This paragraph only applies in the
following settings:

end insert

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

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

begin delete

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

end delete begin insert

(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, and defined as a
direct provisional restoration placed to stabilize the tooth until a
licensed dentist diagnoses the need for further definitive treatment.
An interim therapeutic restoration consists of the removal of soft
material from the tooth using only hand instrumentation, without
the use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary for interim therapeutic restoration placement. Interim
therapeutic restorations shall be placed only in accordance with
both of the following:

end insert

(A) In either of the following settings:

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

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

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

begin insert

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

end insert begin insert

(c) The board shall promulgate regulations establishing criteria
for approval of courses of instruction for the procedures authorized
to be performed by a registered dental assistant in extended
functions pursuant to this section. The committee shall review
proposed regulations, and any subsequent proposed amendments
to the promulgated regulations, and shall submit any recommended
changes to the board for review to establish a consensus.

end insert begin delete

(c)

end delete

begin insert (d) end insert  This section shall become operative on January 1, 2018.

begin delete

SEC. 4.  

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) 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 remain in effect only until January 1, 2018,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2018, deletes or extends that date.

SEC. 5.  

Section 1753.6 is added to the Business and Professions
Code, 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) of Section 1753.5, procedures specified in Section
1753.55, 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, 2018.

SEC. 6.  

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) 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 caries using hand instruments and placement of an adhesive
restorative material, upon the order of a licensed dentist.

end delete

begin delete SEC. 7. end delete
begin insert SEC. 4. end insert   

Section 1910.5 is added to the Business and Professions
Code, to read:

begin delete

1910.5.  

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

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

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

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

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

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

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

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

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

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

end delete

begin insert

begin insert 1910.5. end insert   

end insert begin insert

(a) In addition to the duties specified in Section 1910,
a registered dental hygienist is authorized to perform the following
additional duties, as specified:

end insert begin insert

(1) Determine which radiographs to perform on a patient who
has not received an initial examination by the supervising dentist
for the specific purpose of the dentist making a diagnosis and
treatment plan for the patient. In these circumstances, the dental
hygienist shall follow protocols established by the supervising
dentist. This paragraph shall only apply in the following settings:

end insert

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

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

begin delete

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

end delete begin insert

(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, and defined as a
direct provisional restoration placed to stabilize the tooth until a
licensed dentist diagnoses the need for further definitive treatment.
An interim therapeutic restoration consists of the removal of soft
material from the tooth using only hand instrumentation, without
the use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary for interim therapeutic restoration placement. Interim
therapeutic restorations shall be placed only in accordance with
both of the following:

end insert

(A) In either of the following settings:

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

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

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

begin delete

(c)

end delete

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

begin insert

(1) No later than January 1, 2018, the dental board shall
promulgate regulations establishing criteria for approval of
courses of instruction for the procedures authorized to be
performed by a registered dental hygienist pursuant to this section.
Proposed regulations, and any subsequent proposed amendments
to the promulgated regulations, shall be reviewed by the committee.
The committee shall submit any recommended changes to the board
for review to establish a consensus.

end insert begin insert

(2) Prior to January 1, 2018, the dental board shall use the
competency-based training protocols established by Health
Workforce Pilot Project (HWPP) No. 172 through the Office of
Statewide Health Planning and Development.

end insert begin delete

(1)

end delete

begin insert (3) end insert  A registered dental hygienist who has completed the
prescribed training in the Health Workforce Pilot Project begin delete #172 end delete begin insert No.
172 end insert established by the Office of Statewide Health Planning and
Development pursuant to Article 1 (commencing with Section
128125) of Chapter 3 of Part 3 of Division 107 of the Health and
Safety Code shall be deemed to have satisfied the requirement for
completion of a course of instruction approved by the committee.

begin delete

(2)

end delete

begin insert (4) end insert  In addition to the instructional components described in
subdivision (d) or (e), a program shall contain both of the
instructional components described in this paragraph:

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

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

begin delete

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

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

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

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

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

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

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

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

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

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

(A) Pulpal anatomy.

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

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

(i) Patient factors:

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

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

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

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

(ii) Tooth factors:

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

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

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

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

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

(i) The restorative material is not in hyperocclusion.

(ii) There are no marginal voids.

(iii) There is minimal excess material.

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

(F) Protocols for followup of adhesive protective restorations.

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

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

(f)

end delete

begin insert (c) end insert  This section shall remain in effect only until January 1, 2018,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2018, deletes or extends that date.

begin delete SEC. 8. end delete
begin insert SEC. 5. end insert   

Section 1910.5 is added to the Business and Professions
Code, to read:

begin delete

1910.5.  

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

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

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

end delete

begin insert

begin insert 1910.5. end insert   

end insert begin insert

(a) In addition to the duties specified in Section 1910,
a registered dental hygienist is authorized to perform the following
additional duties, as specified:

end insert begin insert

(1) Determine which radiographs to perform on a patient who
has not received an initial examination by the supervising dentist
for the specific purpose of the dentist making a diagnosis and
treatment plan for the patient. In these circumstances, the dental
hygienist shall follow protocols established by the supervising
dentist. This paragraph only applies in the following settings:

end insert

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

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

(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, begin delete as end delete begin insert and end insert defined begin delete by
subdivision (a), that comprise the removal of soft material from
the tooth using only hand instrumentation, without the use of rotary
instrumentation, and subsequent placement of an adhesive
restorative material. Local anesthesia shall not be necessary. The
protective restorations end delete begin insert as a direct provisional restoration placed
to stabilize the tooth until a licensed dentist diagnoses the need
for further definitive treatment. An interim therapeutic restoration
consists of the removal of soft material from the tooth using only
hand instrumentation, without the use of rotary instrumentation,
and subsequent placement of an adhesive restorative material.
Local anesthesia shall not be necessary for interim therapeutic
restoration placement. Interim therapeutic restorations end insert shall be
placed only in accordance with both of the following:

(A) In either of the following settings:

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

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

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

begin delete

(c)

end delete

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

begin insert

(c) The dental board shall promulgate regulations establishing
criteria for approval of courses of instruction for the procedures
authorized to be performed by a registered dental hygienist
pursuant to this section. The committee shall review proposed
regulations, and any subsequent proposed amendments to the
promulgated regulations, and shall submit any recommended
changes to the board for review to establish a consensus.

end insert

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

begin delete SEC. 9. end delete
begin insert SEC. 6. end insert   

Section 1926 of the Business and Professions Code is
amended to read:

1926.  

A registered dental hygienist in alternative practice may
perform the duties authorized pursuant to subdivision (a) of Section
1907, subdivision (a) of Section 1908, subdivisions (a) and (b) of
Section 1910, and Section 1926.05 in the following settings:

(a) Residences of the homebound.

(b) Schools.

(c) Residential facilities and other institutions.

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

begin delete SEC. 10. end delete
begin insert SEC. 7. end insert   

Section 1926.05 is added to the Business and
Professions Code, to read:

begin delete

1926.05.  

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

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

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

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

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

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

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

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

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

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

end delete

begin insert

begin insert 1926.05. end insert   

end insert begin insert

(a) In addition to the duties specified in Section 1926,
a registered dental hygienist in alternative practice is authorized
to perform the following additional duties, as specified:

end insert begin insert

(1) Determine which radiographs to perform on a patient who
has not received an initial examination by the supervising dentist
for the specific purpose of the dentist making a diagnosis and
treatment plan for the patient. In these circumstances, the dental
hygienist in alternative practice shall follow protocols established
by the supervising dentist. This paragraph only applies in the
following settings:

end insert

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

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

begin delete

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

end delete begin insert

(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, and defined as a
direct provisional restoration placed to stabilize the tooth until a
licensed dentist diagnoses the need for further definitive treatment.
An interim therapeutic restoration consists of the removal of soft
material from the tooth using only hand instrumentation, without
the use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary for interim therapeutic restoration placement. Interim
therapeutic restorations shall be placed only in accordance with
both of the following:

end insert

(A) In either of the following settings:

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

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

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

begin delete

(c)

end delete

begin insert (b) end insert  The functions described in subdivision begin delete (b) end delete begin insert (a) end insert may be
performed by a registered dental hygienist in alternative practice
only after completion of a course or program that includes training
in performing those functions, or after providing evidence,
satisfactory to the committee, of having completed a
committee-approved course in those functions.

begin insert

(1) No later than January 1, 2018, the dental board shall
promulgate regulations establishing criteria for the approval of
courses of instruction for the procedures authorized to be
performed by a registered dental hygienist in alternative practice
pursuant to this section. Proposed regulations, and any subsequent
proposed amendments to the promulgated regulations, shall be
reviewed by the committee. The committee shall submit any
recommended changes to the board for review to establish a
consensus.

end insert begin insert

(2) Prior to January 1, 2018, the dental board shall use the
competency-based training protocols established by Health
Workforce Pilot Project (HWPP) No. 172 through the Office of
Statewide Health Planning and Development.

end insert begin delete

(1)

end delete

begin insert (3) end insert  A registered dental hygienist in alternative practice who has
completed the prescribed training in the Health Workforce Pilot
Project begin delete #172 end delete begin insert No. 172 end insert established by the Office of Statewide Health
Planning and Development pursuant to Article 1 (commencing
with Section 128125) of Chapter 3 of Part 3 of Division 107 of
the Health and Safety Code shall be deemed to have satisfied the
requirement for completion of a course of instruction approved by
the committee.

begin delete

(2)

end delete

begin insert (4) end insert  In addition to the instructional components described in begin insert this end insert
subdivision begin delete (d) or (e) end delete , a program shall contain both of the
instructional components described in this paragraph:

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

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

begin delete

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

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

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

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

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

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

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

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

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

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

(A) Pulpal anatomy.

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

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

(i) Patient factors:

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

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

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

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

(ii) Tooth factors:

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

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

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

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

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

(i) The restorative material is not in hyperocclusion.

(ii) There are no marginal voids.

(iii) There is minimal excess material.

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

(F) Protocols for followup of adhesive protective restorations.

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

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

(f)

end delete

begin insert (c) end insert  This section shall remain in effect only until January 1, 2018,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2018, deletes or extends that date.

begin delete SEC. 11. end delete
begin insert SEC. 8. end insert   

Section 1926.05 is added to the Business and
Professions Code, to read:

begin delete

1926.05.  

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

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

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

end delete

begin insert

begin insert 1926.05. end insert   

end insert begin insert

(a) In addition to the duties specified in Section 1926,
a registered dental hygienist in alternative practice is authorized
to perform the following additional duties, as specified:

end insert begin insert

(1) Determine which radiographs to perform on a patient who
has not received an initial examination by the supervising dentist
for the specific purpose of the dentist making a diagnosis and
treatment plan for the patient. In these circumstances, the dental
hygienist in alternative practice shall follow protocols established
by the supervising dentist. This paragraph only applies in the
following settings:

end insert

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

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

begin delete

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

end delete begin insert

(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, and defined as a
direct provisional restoration placed to stabilize the tooth until a
licensed dentist diagnoses the need for further definitive treatment.
An interim therapeutic restoration consists of the removal of soft
material from the tooth using only hand instrumentation, without
the use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary for interim therapeutic restoration placement. Interim
therapeutic restorations shall be placed only in accordance with
both of the following:

end insert

(A) In either of the following settings:

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

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

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

begin delete

(c)

end delete

begin insert (b) end insert  The functions described in begin delete subdivision (b) end delete begin insert this section end insert may
be performed by a registered dental hygienist in alternative practice
only after completion of a course or program that includes training
in performing those functions, or after providing evidence,
satisfactory to the committee, of having completed a
committee-approved course in those functions.

begin insert

(c) The dental board shall promulgate regulations establishing
criteria for approval of courses of instruction for the procedures
authorized to be performed by a registered dental hygienist in
alternative practice pursuant to this section. The committee shall
review proposed regulations, and any subsequent proposed
amendments to the promulgated regulations, and shall submit any
recommended changes to the board for review to establish a
consensus.

end insert

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

begin insert

begin insert SEC. 9. end insert   

end insert

begin insert Section 128196 is added to the end insert begin insert Health and Safety Code end insert begin insert ,
to read: end insert

begin insert

begin insert 128196. end insert   

(a) Notwithstanding Section 128180, the office shall
extend the duration of the health workforce project known as
Health Workforce Pilot Project No. 172 until January 1, 2016, in
order to maintain the competence of the clinicians trained during
the course of the project, and to authorize training of additional
clinicians in the duties specified in HWPP No. 172.

(b) This section shall remain in effect only until January 1, 2016,
and as of that date is repealed, unless a later enacted statute, that
is enacted before January 1, 2016, deletes or extends that date.

end insert

begin delete SEC. 12. end delete
begin insert SEC. 10. end insert   

Section 14132.725 of the Welfare and Institutions
Code is amended to read:

14132.725.  

(a) 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, teledermatology, and 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) For purposes of this section, “teleophthalmology,
teledermatology, and teledentistry by store and forward” means
an asynchronous transmission of medical or dental information to
be reviewed at a later time by a physician at a distant site who is
trained in ophthalmology or dermatology or, for teleophthalmology,
by an optometrist who is licensed pursuant to Chapter 7
(commencing with Section 3000) of Division 2 of the Business
and Professions Code, or a dentist, where the physician,
optometrist, or dentist at the distant site reviews the medical or
dental information without the patient being present in real time.
A patient receiving teleophthalmology, teledermatology, or
teledentistry by store and forward shall be notified of the right to
receive interactive communication with the distant specialist
physician, optometrist, or dentist and shall receive an interactive
communication with the distant specialist physician, optometrist,
or dentist, upon request. If requested, communication with the
distant specialist physician, optometrist, or 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. If the reviewing
optometrist identifies a disease or condition requiring consultation
or referral pursuant to Section 3041 of the Business and Professions
Code, that consultation or referral shall be with an ophthalmologist
or other appropriate physician and surgeon, as required.

(c) 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.

begin delete

(d) On or before January 1, 2008, 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
telehealth as provided, under this section as a Medi-Cal benefit.

end delete