Amended in Senate July 2, 2014

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 1684.5 and begin delete 1926 end delete begin insert 1944 end insert of, begin insert to add Section 1926.05 to, end insert and to add, repeal, and add Sections 1753.55 begin delete , end delete begin insert and end insert 1910.5 begin delete , and 1926.05 end delete of, the Business and Professions Code, and to add and repeal Section 128196 of the Health and Safety Code, 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 professionals.

(1) Under existing law, the Dental Practice Act, the Dental Board of California licenses and regulates dentists. 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, 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.

This bill would add to those specified duties begin delete determining and performing end delete begin insert exposing end insert 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 begin insert a total of end insert 5 dental auxiliaries, as specified. The bill would authorize specified registered dental assistants in extended functions, registered dental hygienists, and registered dental hygienists in alternative practice to determine which radiographs to perform and to place protective restorations, as specified. 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.

begin insert

(2) Existing law requires the committee to establish by resolution the amount of the fees that relate to the licensing of a registered dental hygienist, registered dental hygienist in alternative practice, and registered dental hygienist in extended functions. Existing law limits the fee for each review of courses required for licensure that are not accredited to $300. Under existing law, those fees are further limited to the reasonable regulatory cost incurred by the committee.

end insert begin insert

This bill would instead limit the fee for each review or approval of course requirements for licensure or procedures that require additional training that are not accredited to $750.

end insert begin delete

(2)

end delete

begin insert ( end insert begin insert 3) end insert  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 delete

(3)

end delete

begin insert ( end insert begin insert 4) end insert  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.

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

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

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

SECTION 1.  

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

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

(2)  begin delete Determine end delete begin insert If the dental auxiliary is a registered dental
assistant in extended functions, a registered dental hygienist, or
a registered dental hygienist in alternative practice, determine end insert
and perform radiographs for the specific purpose of aiding a dentist
in completing a comprehensive diagnosis and treatment plan for
a patient begin insert using telehealth, as defined by Section 2290.5, for the
purpose of communication with the supervising dentist end insert pursuant
to Sections 1753.55, 1910.5, and 1926.05.

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

(4) 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.

(c) For purposes of this section, if dental treatment is provided
to a patient by a begin delete dental auxiliary end delete begin insert registered dental assistant in
extended functions, a registered dental hygienist, or a registered
dental hygienist in alternative practice end insert pursuant to the diagnosis
and treatment plan authorized by a supervising dentist, begin delete the
supervising dentist shall ensure end delete begin insert at a location other than the
dentist’s practice location, it is the responsibility of the authorizing
dentist end insert that the patient or the patient’s representative begin delete is notified in
writing of the supervising end delete begin insert receive written notification that the care
was provided at the direction of the authorizing dentist and that
the notification include the authorizing end insert dentist’s name, practice
location address, begin insert and end insert telephone begin delete number, and email address, and
that the care was provided at the direction of the dentist. end delete begin insert number.
This provision shall not require patient notification for dental
hygiene preventive services provided in public health programs
as specified and authorized in Section 1911, or for dental hygiene
care when provided as specified and authorized in Section 1926. end insert

(d) A dentist shall not concurrently supervise more than begin insert a total
of end insert five begin delete dental auxiliaries end delete begin insert registered dental assistants in extended
functions, end insert begin insert registered dental hygienists, or end insert begin insert registered dental
hygienists in alternative practice end insert providing services pursuant to
Sections 1753.55, 1910.5, and 1926.05.

(e) 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.

(f) 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:

1753.55.  

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

(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:

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

(B) In public health settings, begin insert using telehealth, as defined by
Section 2290.5, for the purpose of communication with the
supervising dentist, end insert including, but not limited to, schools, head
start and preschool programs, and begin delete residential facilities and
institutions end delete begin insert community clinics end insert , under the general supervision of a
dentist.

(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:

(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, begin insert using telehealth, as defined by
Section 2290.5, for the purpose of communication with the
supervising dentist, end insert including, but not limited to, schools, head
start and preschool programs, and begin delete residential facilities and
institutions, end delete begin insert community clinics, end insert under the general supervision of
a dentist.

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

(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.

begin delete

(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 delete begin insert

(1) No later than January 1, 2018, the board shall promulgate
regulations to establish requirements for courses of instruction
for the procedures authorized to be performed by a registered
dental assistant in extended functions pursuant to this section,
using the competency-based training protocols established by the
Health Workforce Pilot Project (HWPP) No. 172 through the
Office of Health Planning and Development. The board shall
submit regulatory language pursuant to approval of courses of
instruction for the Interim Therapeutic Restoration to the committee
for the purpose of promulgating regulations for Registered Dental
Hygienists and Registered Dental Hygienists in Alternative
Practice as described in Section 1910.5. The language submitted
by the board shall mirror the instructional requirements for the
registered dental assistant in extended functions. Any subsequent
amendments to the regulations that are promulgated by the board
for the Interim Therapeutic Restoration course curriculum shall
be submitted to the committee.

end 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 begin insert to approve courses
of instruction for the procedures authorized in this section end insert .

(3) A registered dental assistant in extended functions who has
completed the prescribed training in the Health Workforce Pilot
Project No. 172 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.

(4) In addition to the instructional components described in this
subdivision, 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 insert

(c) The board may issue a permit to a registered dental assistant
in extended functions who files a completed application, including
the fee, to provide the duties specified in this section after the board
has determined the registered dental assistant in extended functions
has completed the coursework required in subdivision (b).

end insert begin delete

(c)

end delete

begin insert ( end insert begin insert d) 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:

1753.55.  

(a) In addition to the duties specified in Section
1753.5, a registered dental assistant in extended functions licensed
on or after January 1, 2010, or having completed the educational
requirements to perform the duties authorized by Section 1753.5
begin insert and 1753.6 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:

(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:

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

(B) In public health settings, begin insert using telehealth, as defined by
Section 2290.5, for the purpose of communication with the
supervising dentist, end insert including, but not limited to, schools, head
start and preschool programs, and begin delete residential facilities and
institutions, end delete begin insert community clinics, end insert under the general supervision of
a dentist.

(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:

(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, begin insert using telehealth, as defined by
Section 2290.5, for the purpose of communication with the
supervising dentist, end insert including, but not limited to, schools, head
start and preschool programs, and begin delete residential facilities and
institutions end delete begin insert community clinics end insert , under the general supervision of a
dentist.

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

(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.

begin delete

(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 delete begin insert

(c) No later than January 1, 2018, the board shall promulgate
regulations to establish requirements for courses of instruction
for the procedures authorized to be performed by a registered
dental assistant in extended functions pursuant to this section using
the competency-based training protocols established by the Health
Workforce Pilot Project (HWPP) No. 172 through the Office of
Health Planning and Development. The board shall submit
regulatory language pursuant to approval of courses of instruction
for the Interim Therapeutic Restoration to the committee for the
purpose of promulgating regulations for registered dental
hygienists and registered dental hygienists in alternative practice
as described in Section 1910.5. The language submitted by the
board shall mirror the instructional requirements for the registered
dental assistant in extended functions. Any subsequent amendments
to the regulations that are promulgated by the board for the Interim
Therapeutic Restoration course curriculum shall be submitted to
the committee.

end insert begin insert

(d) The board may issue a permit to a registered dental assistant
in extended functions who files a completed application, including
the fee, to provide the duties specified in this section after the board
has determined the registered dental assistant in extended functions
has completed the coursework required in subdivision (b).

end insert begin delete

(d)

end delete

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

SEC. 4.  

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

1910.5.  

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

(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:

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

(B) In a public health setting, begin insert using telehealth, as defined by
Section 2290.5, for the purpose of communication with the
supervising dentist, end insert including, but not limited to, schools, head
start and preschool programs, and begin delete residential facilities and
institutions, under the general supervision of a dentist end delete begin insert community
clinics end 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:

(A) In either of the following settings:

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

(ii) In a public health setting, begin insert using telehealth, as defined by
Section 2290.5, for the purpose of communication with the
supervising dentist, end insert including, but not limited to, schools, head
start and preschool programs, and begin delete residential facilities and
institutions, under the general supervision of a dentist end delete begin insert community
clinics end insert .

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

(b) The functions described in subdivision (a) 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 delete

(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 delete begin insert

(c) (1) No later than January 1, 2018, the committee shall
promulgate regulations to establish requirements for courses of
instruction for the procedures authorized to be performed by a
registered dental hygienist and registered dental hygienist in
alternative practice pursuant to Sections 1910.5 and 1926.05 using
the competency-based training protocols established by the Health
Workforce Pilot Project (HWPP) No. 172 through the Office of
Health Planning and Development. The committee shall adopt the
regulatory language for approval of courses of instruction for the
Interim Therapeutic Restoration submitted by the dental board,
pursuant to Section 1753.55 in the regulations. Any subsequent
amendments to the regulations for the Interim Therapeutic
Restoration course curriculum that are promulgated by the
committee shall be agreed upon by the board and the committee.

end insert

(2) Prior to January 1, 2018, the begin delete dental board end delete begin insert committee end insert 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 begin insert to approve courses
of instruction for the procedures authorized in this section end insert .

(3) A registered dental hygienist who has completed the
prescribed training in the Health Workforce Pilot Project No. 172
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.

(4) 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

(c)

end delete

begin insert ( end insert begin insert d) 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. 5.  

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

1910.5.  

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

(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:

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

(B) In a public health setting, begin insert using telehealth, as defined by
Section 2290.5, for the purpose of communication with the
supervising dentist, end insert including, but not limited to, schools, head
start and preschool programs, and begin delete residential facilities and
institutions, under the general supervision of a dentist end delete begin insert community
clinics end 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:

(A) In either of the following settings:

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

(ii) In a public health setting begin insert using telehealth, as defined by
Section 2290.5, for the purpose of communication with the
supervising dentist end insert , including, but not limited to, schools, head
start and preschool programs, and begin delete residential facilities and
institutions, under the general supervision of a dentist end delete begin insert community
clinics end insert .

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

(b) The functions described in subdivision (a) 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 delete

(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 delete begin insert

(c) No later than January 1, 2018, the committee shall
promulgate regulations to establish requirements for courses of
instruction for the procedures authorized to be performed by a
registered dental hygienist and registered dental hygienist in
alternative practice pursuant to Sections 1910.5 and 1926.05,
using the competency-based training protocols established by the
Health Workforce Pilot Project (HWPP) No. 172 through the
Office of Health Planning and Development. The committee shall
adopt the regulatory language for approval of courses of
instruction for the Interim Therapeutic Restoration submitted by
the dental board, pursuant to Section 1753.55 in the regulations.
Any subsequent amendments to the regulations for the Interim
Therapeutic Restoration course curriculum that are promulgated
by the committee shall be agreed upon by the board and the
committee.

end insert

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

begin delete

SEC. 6.  

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.

end delete

begin delete SEC. 7. end delete
begin insert SEC. 6. end insert   

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

1926.05.  

begin delete (a) end delete begin delete   end delete In addition to the duties specified in Section 1926,
a registered dental hygienist in alternative practice is authorized
to perform the begin delete following end delete additional duties begin delete , as end delete specified begin insert in Section
1910.5 upon completion of the courses required in that section, in
the following settings end insert :

begin delete

(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:

(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, 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:

(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.

(b) The functions described in subdivision (a) 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.

(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.

(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.

(3) A registered dental hygienist in alternative practice who has
completed the prescribed training in the Health Workforce Pilot
Project No. 172 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.

(4) In addition to the instructional components described in this
subdivision, 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.

(c) 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.

end delete begin insert

(a) Residences of the homebound.

end insert begin insert

(b) Schools.

end insert begin insert

(c) Residential facilities and other institutions.

end insert

begin delete

SEC. 8.  

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

1926.05.  

(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:

(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:

(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, 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:

(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.

(b) The functions described in this section 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.

(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.

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

end delete

begin insert

begin insert SEC. 7. end insert   

end insert

begin insert Section 1944 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

1944.  

(a) The committee shall establish by resolution the
amount of the fees that relate to the licensing of a registered dental
hygienist, a registered dental hygienist in alternative practice, and
a registered dental hygienist in extended functions. The fees
established by board resolution in effect on June 30, 2009, as they
relate to the licensure of registered dental hygienists, registered
dental hygienists in alternative practice, and registered dental
hygienists in extended functions, shall remain in effect until
modified by the committee. The fees are subject to the following
limitations:

(1) The application fee for an original license and the fee for
issuance of an original license shall not exceed two hundred fifty
dollars ($250).

(2) The fee for examination for licensure as a registered dental
hygienist shall not exceed the actual cost of the examination.

(3) For third- and fourth-year dental students, the fee for
examination for licensure as a registered dental hygienist shall not
exceed the actual cost of the examination.

(4) The fee for examination for licensure as a registered dental
hygienist in extended functions shall not exceed the actual cost of
the examination.

(5) The fee for examination for licensure as a registered dental
hygienist in alternative practice shall not exceed the actual cost of
administering the examination.

(6) The biennial renewal fee shall not exceed one hundred sixty
dollars ($160).

(7) The delinquency fee shall not exceed one-half of the renewal
fee. Any delinquent license may be restored only upon payment
of all fees, including the delinquency fee, and compliance with all
other applicable requirements of this article.

(8) The fee for issuance of a duplicate license to replace one
that is lost or destroyed, or in the event of a name change, shall
not exceed twenty-five dollars ($25) or one-half of the renewal
fee, whichever is greater.

(9) The fee for certification of licensure shall not exceed one-half
of the renewal fee.

(10) The fee for each curriculum review and site evaluation for
educational programs for dental hygienists who are not accredited
by a committee-approved agency shall not exceed two thousand
one hundred dollars ($2,100).

begin delete

(11) The fee for each review of courses required for licensure
that are not accredited by a committee-approved agency, the
Council for Private Postsecondary and Vocational Education, or
the Chancellor’s Office of the California Community Colleges
shall not exceed three hundred dollars ($300).

end delete begin insert

(11) The fee for each review or approval of course requirements
for licensure or procedures that require additional training that
are not accredited by a committee-approved agency shall not
exceed seven hundred fifty dollars ($750).

end insert

(12) The initial application and biennial fee for a provider of
continuing education shall not exceed five hundred dollars ($500).

(13) The amount of fees payable in connection with permits
issued under Section 1962 is as follows:

(A) The initial permit fee is an amount equal to the renewal fee
for the applicant’s license to practice dental hygiene in effect on
the last regular renewal date before the date on which the permit
is issued.

(B) If the permit will expire less than one year after its issuance,
then the initial permit fee is an amount equal to 50 percent of the
renewal fee in effect on the last regular renewal date before the
date on which the permit is issued.

(b) The renewal and delinquency fees shall be fixed by the
committee by resolution at not more than the current amount of
the renewal fee for a license to practice under this article nor less
than five dollars ($5).

(c) Fees fixed by the committee by resolution pursuant to this
section shall not be subject to the approval of the Office of
Administrative Law.

(d) Fees collected pursuant to this section shall be collected by
the committee and deposited into the State Dental Hygiene Fund,
which is hereby created. All money in this fund shall, upon
appropriation by the Legislature in the annual Budget Act, be used
to implement the provisions of this article.

(e) No fees or charges other than those listed in this section shall
be levied by the committee in connection with the licensure of
registered dental hygienists, registered dental hygienists in
alternative practice, or registered dental hygienists in extended
functions.

(f) The fee for registration of an extramural dental facility shall
not exceed two hundred fifty dollars ($250).

(g) The fee for registration of a mobile dental hygiene unit shall
not exceed one hundred fifty dollars ($150).

(h) The biennial renewal fee for a mobile dental hygiene unit
shall not exceed two hundred fifty dollars ($250).

(i) The fee for an additional office permit shall not exceed two
hundred fifty dollars ($250).

(j) The biennial renewal fee for an additional office as described
in Section 1926.4 shall not exceed two hundred fifty dollars ($250).

(k) The initial application and biennial special permit fee is an
amount equal to the biennial renewal fee specified in paragraph
(6) of subdivision (a).

(l) The fees in this section shall not exceed an amount sufficient
to cover the reasonable regulatory cost of carrying out the
provisions of this article.

begin delete SEC. 9. end delete
begin insert SEC. 8. end insert   

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

128196.  

(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.

begin delete SEC. 10. end delete
begin insert SEC. 9. 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.