Second Regular Session Seventy-third General Assembly STATE OF COLORADO ENGROSSED This Version Includes All Amendments Adopted on Second Reading in the House of Introduction LLS NO. 22-0229.01 Yelana Love x2295 SENATE BILL 22-219 Senate Committees House Committees Health & Human Services Finance Appropriations A BILL FOR AN ACT C ONCERNING THE REGULATION OF DENTAL THERAPISTS , AND, IN 101 CONNECTION THEREWITH , MAKING AN APPROPRIATION .102 Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov .) On and after January 1, 2023, the bill prohibits a person from practicing dental therapy in the state unless licensed by the Colorado dental board (board). A licensed dental therapist is authorized to deliver routine and preventive dental care. A person who desires to qualify for practice as a dental therapist must file with the board a written application for a license, proof of SENATE Amended 2nd Reading April 29, 2022 SENATE SPONSORSHIP Moreno and Smallwood, HOUSE SPONSORSHIP Duran and McLachlan, Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment. Capital letters or bold & italic numbers indicate new material to be added to existing statute. Dashes through the words indicate deletions from existing statute. graduation from a school of dental therapy or a dental therapy program that meets the requirements of the bill, and proof of completion of the examinations required for licensure as a dental hygienist. A dental therapist is allowed to practice only under the direct supervision of a licensed dentist until the dental therapist practices for 1,000 hours. After reaching 1,000 hours, the dental therapist may practice under the indirect supervision of a licensed dentist pursuant to a written articulated plan. The articulated plan must include: ! Methods of dentist supervision, consultation, and approval; ! Protocols for informed consent, record keeping, quality assurance, and dispensing or administering medications; ! Policies for handling referrals when a patient needs services the dental therapist is not authorized or qualified to provide; ! Policies for handling medical emergencies; and ! Policies for supervising dental assistants and working with dental hygienists and other dental practitioners and staff. A licensed dental therapist must maintain professional liability insurance in an amount not less than $500,000 per incident and $1.5 million annual aggregate per year; except that this requirement is not applicable to a dental therapist who is a public employee under the "Colorado Governmental Immunity Act". A state institution of higher education offering an accredited dental therapy training program may grant advanced standing toward completion of an accredited dental therapy program if a student meets the conditions specified in the bill. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. Legislative declaration. (1) The general assembly2 hereby finds and declares that:3 (a) Access to affordable, quality, and equitable dental care and to4 dental providers has been demonstrated to have a positive impact on5 people's overall health outcomes and overall well-being;6 (b) Although great strides have been made toward increasing7 access to affordable dental care, not enough has been accomplished to8 address oral-health-access issues across Colorado, particularly in the9 state's rural areas, and for Coloradans who have historically and10 219-2- systematically faced barriers to health care, including people of color and1 Coloradans with low incomes;2 (c) According to the "Colorado Health Access Survey" (survey)3 by the Colorado Health Institute, roughly one in five Coloradans report4 poor oral health;5 (d) In the survey, 400,000 Coloradans said that at some point in6 the past year, they were unable to participate in regular daily activities7 like school or work due to dental pain;8 (e) Fifty-three of Colorado's 64 counties are designated as dental9 professional shortage areas, with five counties without a single licensed10 dentist;11 (f) Dentist participation in Medicaid sits at 59.9%, but in 2018,12 only 28% of Colorado dentists served any Medicaid-enrolled patients;13 (g) Adults in rural areas have almost twice the prevalence of tooth14 loss when compared to urban adults;15 (h) By kindergarten, 40% of children in Colorado already have16 dental decay, and this rate increases for children living in low-income17 communities. Dental health issues continue to be a leading cause of18 school absenteeism for Colorado's kids.19 (i) Research has shown that dental therapists practicing in other20 states provide safe and high-quality care, assist in improving access to21 dental care, and experience high patient acceptability;22 (j) A long-term study of dental therapists in the country found that23 dental therapists are improving access to care, resulting in both adults and24 children getting more preventive care and keeping their natural teeth; and25 (k) In order to ensure dental care is accessible for all Coloradans,26 it is critical that the state establish a license for dental therapists to help27 219 -3- close the historic gaps and barriers that Coloradans face in accessing1 dental care.2 SECTION 2. In Colorado Revised Statutes, amend 12-220-1023 as follows:4 12-220-102. Legislative declaration. The practice of dentistry,5 DENTAL THERAPY, and dental hygiene in this state is declared to affect the6 public health, safety, and welfare and to be subject to regulation and7 control in the public interest. It is further declared to be a matter of public8 interest and concern that the dental profession merit and receive the9 confidence of the public and that only qualified dentists, DENTAL10 THERAPISTS, and dental hygienists be permitted to practice dentistry,11 DENTAL THERAPY, or dental hygiene in this state. It is the purpose of this12 article 220 to promote the public health, safety, and welfare by regulating13 the practice of dentistry, DENTAL THERAPY, and dental hygiene and to14 ensure that no one shall practice PRACTICES dentistry, DENTAL THERAPY,15 or dental hygiene without qualifying under this article 220. The16 provisions of this article 220 relating to licensure by credentials are not17 intended to reduce competition or restrain trade with respect to the oral18 health needs of the public. All provisions of this article 220 relating to the19 practice of dentistry, DENTAL THERAPY, and dental hygiene shall be20 liberally construed to carry out these objects and purposes.21 SECTION 3. In Colorado Revised Statutes, 12-220-104, amend22 (1), (3), (13), and (15); and add (5.5) as follows:23 12-220-104. Definitions - rules. As used in this article 220, unless24 the context otherwise requires:25 (1) "Accredited" means a program that is nationally recognized for26 specialized accrediting for dental, DENTAL THERAPY, dental hygiene, and27 219 -4- dental auxiliary programs by the United States department of education.1 (3) "Dental assistant" means any person, other than a dentist,2 DENTAL THERAPIST, or dental hygienist, licensed in Colorado, who may3 be assigned or delegated to perform dental tasks or procedures as4 authorized by this article 220 or by rules of the board.5 (5.5) "D ENTAL THERAPY" MEANS THE DELIVERY OF DENTAL CARE6 AS SPECIFIED IN SECTION 12-220-507 AND IN ACCORDANCE WITH THIS7 ARTICLE 220 AND RULES PROMULGATED BY THE BOARD .8 (13) "Proprietor" includes any person who:9 (a) Employs dentists, DENTAL THERAPISTS, dental hygienists, or10 dental assistants in the operation of a dental office, except as provided in11 sections 12-220-305 and 12-220-501;12 (b) Places in possession of a dentist, DENTAL THERAPIST, dental13 hygienist, dental assistant, or other agent dental material or equipment14 that may be necessary for the management of a dental office on the basis15 of a lease or any other agreement for compensation for the use of the16 material, equipment, or offices; or17 (c) Retains the ownership or control of dental equipment or18 material or a dental office and makes the same available in any manner19 for use by dentists, DENTAL THERAPISTS, dental hygienists, dental20 assistants, or other agents; except that nothing in this subsection (13)(c)21 applies to bona fide sales of dental equipment or material secured by a22 chattel mortgage or retain-title agreement or to the loan of articulators.23 (15) "Telehealth supervision" means indirect supervision by a24 dentist of a DENTAL THERAPIST OR dental hygienist performing a25 statutorily authorized procedure using telecommunications systems.26 SECTION 4. In Colorado Revised Statutes, add 12-220-407.227 219 -5- and 12-220-407.5 as follows:1 12-220-407.2. Application for dental therapist license - fee -2 rules. (1) E FFECTIVE MAY 1, 2023, EVERY PERSON WHO DESIRES TO3 QUALIFY FOR PRACTICE AS A DENTAL THERAPIST WITHIN THIS STATE MUST4 FILE WITH THE BOARD:5 (a) A WRITTEN APPLICATION FOR A LICENSE , ON WHICH6 APPLICATION THE APPLICANT MUST LIST:7 (I) A NY ACT OR OMISSION OF THE APPLICANT THAT WOULD BE8 GROUNDS FOR DISCIPLINARY ACTION UNDER SECTION 12-220-201 AGAINST9 A LICENSED DENTAL THERAPIST; AND10 (II) A N EXPLANATION OF THE CIRCUMSTANCES OF THE ACT OR11 OMISSION; AND12 (b) S ATISFACTORY PROOF THAT THE APPLICANT :13 (I) G RADUATED FROM A SCHOOL OF DENTAL THERAPY THAT , AT14 THE TIME OF THE APPLICANT'S GRADUATION, WAS ACCREDITED BY THE15 A MERICAN DENTAL ASSOCIATION'S COMMISSION ON DENTAL16 ACCREDITATION, OR ITS SUCCESSOR ORGANIZATION; OR17 (II) G RADUATED FROM A DENTAL THERAPY EDUCATION PROGRAM18 DEVELOPED PRIOR TO FEBRUARY 6, 2015, THAT, AT THE TIME OF THE19 APPLICANT'S GRADUATION, WAS ACCREDITED BY THE MINNESOTA BOARD20 OF DENTISTRY OR CERTIFIED BY THE ALASKA COMMUNITY HEALTH AIDE21 PROGRAM CERTIFICATION BOARD .22 (2) T HE APPLICANT MUST APPLY FOR A DENTAL THERAPIST LICENSE23 ON THE FORM PRESCRIBED AND FURNISHED BY THE BOARD , MUST CERTIFY 24 THE APPLICATION UNDER PENALTY OF PERJURY , AND MUST SUBMIT THE25 FEE ESTABLISHED PURSUANT TO SECTION 12-20-105 WITH THE26 APPLICATION.27 219 -6- (3) AN APPLICANT FOR LICENSURE WHO HAS NOT GRADUATED1 FROM A SCHOOL DESCRIBED IN SUBSECTION (1)(b) OF THIS SECTION WITHIN2 THE TWELVE MONTHS IMMEDIATELY PRECEDING APPLICATION , OR WHO3 HAS NOT ENGAGED EITHER IN THE ACTIVE CLINICAL PRACTICE OF DENTAL4 THERAPY OR IN TEACHING DENTAL THERAPY IN AN ACCREDITED PROGRAM5 FOR AT LEAST ONE YEAR DURING THE FIVE YEARS IMMEDIATELY6 PRECEDING THE APPLICATION, MUST DEMONSTRATE TO THE BOARD THAT7 THE APPLICANT HAS MAINTAINED THE PROFESSIONAL ABILITY AND8 KNOWLEDGE REQUIRED BY THIS ARTICLE 220.9 12-220-407.5. Dental therapist examinations - license.10 (1) E VERY APPLICANT FOR A DENTAL THERAPY LICENSE MUST SUBMIT TO11 THE BOARD PROOF THAT THE APPLICANT SUCCESSFULLY COMPLETED A 12 CLINICAL EXAMINATION FOR DENTAL THERAPY THAT :13 (a) I S DESIGNED TO TEST THE APPLICANT 'S CLINICAL DENTAL 14 THERAPY SKILLS AND KNOWLEDGE ;15 (b) I NCLUDES DENTAL THERAPY RESTORATIVE AND DENTAL 16 HYGIENE CLINICAL SKILL EVALUATION ; AND17 (c) I S ADMINISTERED BY A REGIONAL TESTING AGENCY COMPOSED 18 OF AT LEAST FOUR STATES OR AN EXAMINATION OF ANOTHER STATE .19 (2) A LL EXAMINATION RESULTS REQUIRED BY THE BOARD MUST BE20 FILED WITH THE BOARD AND KEPT FOR REFERENCE FOR A PERIOD OF NOT21 LESS THAN TWO YEARS. IF AN APPLICANT SUCCESSFULLY COMPLETES THE22 EXAMINATIONS AND IS OTHERWISE QUALIFIED , THE BOARD SHALL GRANT23 A LICENSE TO THE APPLICANT AND SHALL ISSUE A LICENSE CERTIFICATE24 SIGNED BY THE OFFICERS OF THE BOARD.25 (3) F OR THE PURPOSE OF COMPLETING THE EXAMINATION 26 REQUIREMENT IN SUBSECTION (1) OF THIS SECTION, IF THE APPLICANT HAS27 219 -7- PREVIOUSLY SUCCESSFULLY COMPLETED A CLINICAL EXAMINATION FOR1 DENTAL HYGIENE ADMINISTERED BY A TESTING AGENCY ACCEPTED BY THE2 BOARD, THE APPLICANT MAY BE EXEMPTED FROM THAT PART OF THE3 DENTAL THERAPY EXAMINATION .4 SECTION 5. In Colorado Revised Statutes, 12-220-501, amend5 (1)(a)(I); and add (2.5) as follows:6 12-220-501. Tasks authorized to be performed by dental7 therapists, dental hygienists, or dental assistants - rules.8 (1) (a) (I) Except as provided in subsection (1)(a)(II) of this section, the9 responsibility for dental diagnosis, dental treatment planning, or the10 prescription of therapeutic measures in the practice of dentistry remains11 with a licensed dentist and may not be assigned to any DENTAL THERAPIST12 OR dental hygienist.13 (2.5) A DENTAL THERAPIST MAY PERFORM A DENTAL TASK OR14 PROCEDURE ASSIGNED TO THE DENTAL THERAPIST BY A LICENSED DENTIST15 THAT DOES NOT REQUIRE THE PROFESSIONAL SKILL OF A LICENSED16 DENTIST; EXCEPT THAT THE DENTAL THERAPIST MAY PERFORM THE TASK 17 OR PROCEDURE ONLY UNDER THE SUPERVISION AUTHORIZED UNDER18 SECTION 12-220-507.19 SECTION 6. In Colorado Revised Statutes, add 12-220-507 as20 follows:21 12-220-507. Practice of dental therapy supervision22 requirement - rules. (1) (a) A DENTAL THERAPIST MAY PERFORM THE 23 FOLLOWING TASKS AND PROCEDURES UNDER THE DIRECT SUPERVISION OF24 A LICENSED DENTIST:25 (I) P REPARE AND PLACE DIRECT RESTORATIONS IN PRIMARY AND 26 PERMANENT TEETH;27 219 -8- (II) PERFORM BRUSH BIOPSIES;1 (III) E XTRACT PERIODONTALLY DISE ASED PERMANENT TEETH WITH 2 MOBILITY OF +3 TO +4, EXCEPT FOR TEETH THAT ARE UNERUPTED ,3 IMPACTED, FRACTURED, OR REQUIRE SECTIONING;4 (IV) E XTRACT PRIMARY TEETH THAT ARE ERUPTED OR NOT 5 IMPACTED WITH RADIOLOGICAL EVIDENCE OF ROOTS ;6 (V) O RAL EXAMINATION AND EVALUATION FOR CONDITIONS AND 7 SERVICES THAT ARE WITHIN THE DENTAL THERAPIST 'S SCOPE OF PRACTICE8 AND EDUCATION;9 (VI) P LACE TEMPORARY CROWNS ; 10 (VII) P REPARE AND PLACE PREFORMED CROWNS ; AND 11 (VIII) R EPAIR DEFECTIVE PROSTHETIC DEVICES. 12 (b) A DENTAL THERAPIST LICENSED PURSUANT TO THIS ARTICLE 13 220 WHO HAS COMPLETED ONE THOUS AND HOURS OR MORE UNDER DIRECT 14 SUPERVISION, OR WHO HAS COMPLETED THE DIRECT SUPERVISION HOURS15 REQUIRED UNDER THE WAIVER DESCRIBED IN SUBSECTION (1)(e) OF THIS16 SECTION, MAY PRACTICE THE TASKS AND PROCEDURES IDENTIFIED IN17 SUBSECTION (1)(a) OF THIS SECTION UNDER THE INDIRECT SUPERVISION OF18 A LICENSED DENTIST PURSUANT TO A WRITTEN ARTICULATED PLAN WITH19 THE DENTIST THAT MEETS THE REQUIREMENTS OF SUBSECTION (2) OF THIS20 SECTION.21 (c) A DENTAL THERAPIST LICENSED PURSUANT TO THIS ARTICLE 22 220 MAY PERFORM THE FOLLOWING TASKS UNDER THE INDIRECT23 SUPERVISION OF A LICENSED DENTIST, REGARDLESS OF THE NUMBER OF24 HOURS THE DENTAL THERAPIST HAS PRACTICED :25 (I) R EIMPLANTING TEETH;26 (II) S TABILIZING REIMPLANTED TEETH;27 219 -9- (III) EXTRACTING PRIMARY TEETH THAT ARE ERUPTED OR NOT1 IMPACTED WITHOUT RADIOLOGICAL EVIDENCE OF ROOTS ;2 (IV) R EMOVING SUTURES;3 (V) P REPARING DENTAL STUDY CASTS ;4 (VI) A DMINISTERING LOCAL ANESTHESIA IN ACCORDANCE WITH5 SECTION 12-220-411;6 (VII) D ISPENSING AND ADMINISTERING THE FOLLOWING DRUGS7 WITHIN THE PARAMETERS OF A WRITTEN ARTICULATED PLAN AND WITH8 THE AUTHORIZATION OF THE SUPERVISING DENTIST : NONNARCOTIC9 ANALGESICS, ANTI-INFLAMMATORIES, AND ANTIBIOTICS; AND10 (VIII) A NY TASK OR PROCEDURE AUTHORIZED TO BE PERFORMED11 BY A LICENSED DENTAL HYGIENIST AS SPECIFIED IN RULES ADOPTED12 PURSUANT TO SECTIONS 12-220-106 (1)(a)(I), 12-220-501, 12-220-50313 (1), 12-220-504 (1), AND 12-220-505. 14 (d) A DENTAL THERAPIST SHALL COMPLETE AT LEAST A MAJORITY 15 OF THE DIRECT SUPERVISION HOURS REQUIRED UNDER SUBSECTION (1)(b)16 OR (1)(e) PERFORMING THE TASKS AND PROCEDURES IDENTIFIED IN17 SUBSECTION (1)(a) OF THIS SECTION.18 (e) FOR THE PURPOSES OF SATISFYING THE PRACTICE HOURS19 REQUIREMENT SPECIFIED IN SUBSECTION (1)(a) OF THIS SECTION, THE20 BOARD, BY RULE, MAY WAIVE UP TO SIX HUNDRED HOURS OF THE21 REQUIRED PRACTICE HOURS. IN PROMULGATING THESE RULES, THE BOARD22 SHALL, AT A MINIMUM, CONSIDER THE NUMBER OF YEARS THE DENTAL23 THERAPIST HAS PRACTICED AS:24 (I) A LICENSED DENTAL HYGIENIST IN COLORADO;25 (II) A LICENSED DENTAL HYGIENIST IN ANOTHER STATE ; OR26 (III) A LICENSED DENTAL THERAPIST IN ANOTHER STATE .27 219 -10- (2) (a) AN ARTICULATED PLAN BETWEEN A DENTAL THERAPIST AND1 A DENTIST MUST INCLUDE:2 (I) M ETHODS OF DENTIST SUPERVISION , CONSULTATION, AND3 APPROVAL;4 (II) P ROTOCOLS FOR INFORMED CONSENT , RECORD KEEPING,5 QUALITY ASSURANCE, AND DISPENSING OR ADMINISTERING MEDICATIONS ;6 (III) P OLICIES FOR HANDLING REFERRALS WHEN A PATIENT NEEDS7 SERVICES THE DENTAL THERAPIST IS NOT AUTHORIZED OR QUALIFIED TO8 PROVIDE;9 (IV) P ROTOCOLS FOR ASSESSMENT OF DENTAL DISEASE AND THE 10 FORMULATION OF AN INDIVIDUALIZED TREATMENT PLAN AUTHORIZED BY11 THE SUPERVISING DENTIST;12 (V) POLICIES FOR HANDLING MEDICAL EMERGENCIES ; AND13 (VI) POLICIES FOR SUPERVISING DENTAL ASSISTANTS AND14 WORKING WITH DENTAL HYGIENISTS AND OTHER DENTAL PRACTITIONERS15 AND STAFF.16 (b) (I) A DENTIST WHO ENTERS INTO A WRITTEN ARTICULATED 17 PLAN WITH A DENTAL THERAPIST SHALL ENSURE THAT THE DENTIST , OR18 ANOTHER DENTIST, IS AVAILABLE TO THE DENTAL THERAPIST FOR TIMELY19 COMMUNICATION DURING THE DENTAL THERAPIST 'S PROVISION OF CARE20 TO A PATIENT.21 (II) A DENTAL THERAPIST AND A DENTIST WHO ENTER INTO A22 WRITTEN ARTICULATED PLAN SHALL EACH MAINTAIN A PHYSICAL OR23 DIGITAL COPY OF THE PLAN.24 (III) A DENTAL THERAPIST MAY ENTER INTO WRITTEN25 ARTICULATED PLANS WITH MORE THAN ONE DENTIST IF EACH26 ARTICULATED PLAN INCLUDES THE SAME SUPERVISION REQUIREMENTS27 219 -11- AND SCOPE OF PRACTICE.1 (c) A WRITTEN ARTICULATED PLAN MUST BE SIGNED BY THE 2 DENTIST AND THE DENTAL THERAPIST .3 (d) F OR PURPOSES OF THIS SECTION, A WRITTEN ARTICULATED 4 PLAN SATISFIES THE REQUIREMENT OF PRIOR KNOWLEDGE AND CONSENT5 FOR INDIRECT SUPERVISION.6 (3) (a) EXCEPT AS PROVIDED IN SUBSECTION (3)(b) OR (3)(c) OF7 THIS SECTION, A DENTIST MAY NOT SIMULTANEOUSLY SUPERVISE MORE8 THAN THREE FULL-TIME OR FULL-TIME EQUIVALENT DENTAL THERAPISTS .9 (b) A DENTIST MAY SUPERVISE AN ADDITIONAL TWO FULL -TIME OR10 FULL-TIME EQUIVALENT DENTAL THERAPISTS WHO PRACTICE IN A11 FEDERALLY QUALIFIED HEALTH CENTER PURSUANT TO 42 U.S.C. SEC.12 1395x (aa)(4) OR A RURAL HEALTH CLINIC PURSUANT TO 42 U.S.C. SEC.13 1395x (aa)(4).14 (c) THE BOARD SHALL PROMULGATE RULES CREATING A PROCESS15 FOR A DENTIST TO SEEK A WAIVER FROM THE SUPERVISION LIMIT SPECIFIED16 IN SUBSECTION (3)(a) OF THIS SECTION. AT A MINIMUM, THE RULES MUST17 SPECIFY THE APPLICATION PROCESS AND WAIVER REQUIREMENTS .18 19 SECTION 7. In Colorado Revised Statutes, 12-220-105, amend20 (1)(a), (1)(b), (1)(c), (2)(b), and (2)(c) as follows:21 12-220-105. Colorado dental board - qualifications of board22 members - quorum - panel - rules - review of functions - repeal of23 article - repeal. (1) (a) The Colorado dental board is hereby created as24 the agency of this state for the regulation of the practice of dentistry,25 DENTAL THERAPY, AND DENTAL HYGIENE in this state and to carry out the26 purposes of this article 220. The board is subject to the supervision and27 219 -12- control of the division as provided by section 12-20-103 (2).1 (b) (I) EXCEPT AS PROVIDED IN SUBSECTION (1)(b)(II) OF THIS2 SECTION, the board consists of seven dentist members, three dental3 hygienist members, and three members from the public at large. The4 governor shall appoint each member for a term of four years, and each5 member must have the qualifications provided in this article 220. No6 member shall serve more than two consecutive terms of four years. Each7 board member holds office until the member's term expires or until the8 governor appoints a successor. T HIS SUBSECTION (1)(b)(I) IS REPEALED, 9 EFFECTIVE DECEMBER 1, 2031.10 (II) (A) E FFECTIVE JULY 1, 2031, THE BOARD CONSISTS OF SEVEN 11 DENTIST MEMBERS, TWO DENTAL THERAPIST MEMBERS , TWO DENTAL12 HYGIENIST MEMBERS, AND TWO MEMBERS FROM THE PUBLIC AT LARGE .13 T HE GOVERNOR SHALL APPOINT EACH MEMBER FOR A TERM OF FOUR 14 YEARS, AND EACH MEMBER MUST HAVE THE QUALIFICATIONS PROVIDED15 IN THIS ARTICLE 220. A MEMBER SHALL NOT SERVE MORE THAN TWO16 CONSECUTIVE TERMS OF FOUR YEARS . EACH BOARD MEMBER HOLDS17 OFFICE UNTIL THE MEMBER'S TERM EXPIRES OR UNTIL THE GOVERNOR18 APPOINTS A SUCCESSOR.19 (B) A MEMBER SERVING ON THE BOARD AS OF JUNE 30, 2031, MAY 20 SERVE THE MEMBER'S FULL TERM.21 (c) (I) In making appointments to the board, the governor shall22 attempt to create geographical, political, urban, and rural balance among23 the board members. If a vacancy occurs in any board membership before24 the expiration of the member's term, the governor shall fill the vacancy by25 appointment for the remainder of the term in the same manner as in the26 case of original appointments.27 219 -13- (II) (A) IN MAKING APPOINTMENTS OF DENTAL THERAPISTS TO THE1 BOARD, THE GOVERNOR SHALL APPOINT INDIVIDUALS WHO ARE DIVERSE2 WITH REGARD TO RACE , ETHNICITY, IMMIGRATION STATUS, INCOME,3 WEALTH, AGE, ABILITY, SEXUAL ORIENTATION, GENDER IDENTITY, AND4 GEOGRAPHY.5 (B) I N CONSIDERING THE RACIAL AND ETHNIC DIVERSITY OF THE6 DENTAL THERAPISTS APPOINTED TO THE BOARD , THE GOVERNOR SHALL7 ATTEMPT TO ENSURE THAT AT LEAST ONE MEMBER IS A PERSON OF COLOR .8 (C) I N CONSIDERING THE GEOGRAPHIC DIVERSITY OF THE DENTAL9 THERAPISTS APPOINTED TO THE BOARD , THE GOVERNOR SHALL ATTEMPT10 TO APPOINT MEMBERS FROM BOTH RURAL AND URBAN AREAS OF THE11 STATE.12 (2) A person is qualified to be appointed to the board if the13 person:14 (b) Is currently licensed as a dentist, DENTAL THERAPIST, or dental15 hygienist, if fulfilling that position on the board; and16 (c) Has been actively engaged in a clinical practice in this state for17 at least five years immediately preceding the appointment, if fulfilling the18 position of dentist, DENTAL THERAPIST, or dental hygienist on the board. 19 SECTION 8. In Colorado Revised Statutes, 12-220-106, amend20 (1)(a)(I) and (1)(f) as follows:21 12-220-106. Powers and duties of board - rules - limitation on22 authority. (1) The board shall exercise, in accordance with this article23 220, the following powers and duties:24 (a) Make, publish, declare, and periodically review reasonable25 rules pursuant to section 12-20-204, including rules regarding:26 (I) The use of lasers for dental, DENTAL THERAPY, and dental27 219 -14- hygiene purposes within defined scopes of practice, subject to appropriate1 education and training, and with appropriate supervision, as applicable;2 (f) In accordance with section 12-220-411, issue anesthesia and3 sedation permits to licensed dentists, DENTAL THERAPISTS, and dental4 hygienists and set and collect fees for permit issuance. except that the 5 board shall only collect fees for local anesthesia permits issued to dental6 hygienists on or after July 1, 2014.7 SECTION 9. In Colorado Revised Statutes, 12-220-201, amend8 (1)(a), (1)(g), (1)(h), (1)(j)(I), (1)(j)(II), (1)(k), (1)(o), (1)(q), (1)(r), (1)(v)9 introductory portion, (1)(v)(II), (1)(x), (1)(y)(IV), (1)(ee), (1)(ff), and10 (1)(gg) as follows:11 12-220-201. Grounds for disciplinary action - definition.12 (1) The board may take disciplinary action against an applicant or13 licensee in accordance with sections 12-20-404 and 12-220-202 for any14 of the following causes:15 (a) Engaging in fraud, misrepresentation, or deception in applying16 for, securing, renewing, or seeking reinstatement of a license to practice17 dentistry, DENTAL THERAPY, or dental hygiene in this state, in applying for18 professional liability coverage required pursuant to section 12-220-307,19 or in taking the examinations provided for in this article 220;20 (g) Aiding or abetting, in the practice of dentistry, DENTAL21 THERAPY, or dental hygiene, a person who is not licensed to practice22 dentistry, DENTAL THERAPY, or dental hygiene under this article 220 or23 whose license to practice dentistry, DENTAL THERAPY, or dental hygiene24 is suspended;25 (h) Except as otherwise provided in sections 12-220-304,26 12-220-503 (4), and 25-3-103.7, practicing dentistry, DENTAL THERAPY,27 219 -15- or dental hygiene as a partner, agent, or employee of or in joint venture1 with any person who does not hold a license to practice dentistry, DENTAL2 THERAPY, or dental hygiene within this state or practicing dentistry,3 DENTAL THERAPY, or dental hygiene as an employee of or in joint venture4 with any partnership, association, or corporation. A licensee holding a5 license to practice dentistry, DENTAL THERAPY, or dental hygiene in this6 state may accept employment from any person, partnership, association,7 or corporation to examine, prescribe, and treat the employees of the8 person, partnership, association, or corporation.9 (j) (I) Failing to notify the board, as required by section 12-30-10810 (1), of a physical illness, physical condition, or behavioral health, mental11 health, or substance use disorder that renders the licensee unable, or limits12 the licensee's ability, to perform dental, DENTAL THERAPY, or dental13 hygiene services with reasonable skill and with safety to the patient;14 (II) Failing to act within the limitations created by a physical15 illness, physical condition, or behavioral health, mental health, or16 substance use disorder that renders the licensee unable to practice 17 PERFORM dental, DENTAL THERAPY, or dental hygiene services with18 reasonable skill and safety or that may endanger the health or safety of19 persons under his or her THE LICENSEE'S care; or20 (k) Committing an act or omission that constitutes grossly21 negligent dental, DENTAL THERAPY, or dental hygiene practice or that fails22 to meet generally accepted standards of dental, DENTAL THERAPY, or23 dental hygiene practice;24 (o) False billing in the delivery of dental, DENTAL THERAPY, or25 dental hygiene services, including but not limited to, performing one26 service and billing for another, billing for any service not rendered, or27 219 -16- committing a fraudulent insurance act, as defined in section 10-1-128; 1 (q) Failing to notify the board, in writing and within ninety days2 after a judgment is entered, of a final judgment by a court of competent3 jurisdiction in favor of any party and against the licensee involving4 negligent malpractice of dentistry, DENTAL THERAPY, or dental hygiene,5 which notice must contain the name of the court, the case number, and the6 names of all parties to the action;7 (r) Failing to report a dental, DENTAL THERAPY, or dental hygiene8 malpractice judgment or malpractice settlement to the board by the9 licensee within ninety days;10 (v) Sharing any professional fees with anyone except those with11 whom the dentist, DENTAL THERAPIST, or dental hygienist is lawfully12 associated in the practice of dentistry, DENTAL THERAPY, or dental13 hygiene; except that:14 (II) Nothing in this section prohibits a dentist, DENTAL THERAPIST,15 or dental hygienist practice owned or operated by a proprietor authorized16 under section 12-220-303 from contracting with any person or entity for17 business management services or paying a royalty in accordance with a18 franchise agreement if the terms of the contract or franchise agreement do19 not affect the exercise of the independent professional judgment of the20 dentist, DENTAL THERAPIST, or dental hygienist.21 (x) Failure of a DENTAL THERAPIST OR dental hygienist to22 recommend that a patient be examined by a dentist or to refer a patient to23 a dentist when the DENTAL THERAPIST OR dental hygienist detects a24 condition that requires care beyond the scope of practicing DENTAL25 THERAPY OR supervised or unsupervised dental hygiene;26 (y) Engaging in any of the following activities and practices:27 219 -17- (IV) Ordering or performing, without clinical justification, any1 service, X ray, or treatment that is contrary to recognized standards of the2 practice of dentistry, DENTAL THERAPY, or dental hygiene, as interpreted3 by the board;4 (ee) Failing to provide adequate or proper supervision when 5 employing unlicensed persons in a dental or dental hygiene practice OF6 UNLICENSED PERSONS IN DENTAL, DENTAL THERAPY, OR DENTAL HYGIENE7 PRACTICE;8 (ff) Engaging in any conduct that constitutes a crime as defined9 in title 18, which conduct relates to the licensee's practice as a dentist,10 DENTAL THERAPIST, or dental hygienist;11 (gg) Practicing outside the scope of dental, DENTAL THERAPY, or12 dental hygiene practice;13 SECTION 10. In Colorado Revised Statutes, 12-220-202, amend14 (1)(a)(II), (3) introductory portion, (4), and (5)(a) as follows:15 12-220-202. Disciplinary actions - rules. (1) (a) If, after notice16 and hearing conducted in accordance with article 4 of title 24 and section17 12-20-403, the board determines that an applicant or licensee has engaged18 in an act specified in section 12-220-201, the board may:19 (II) Reprimand, censure, or, in accordance with section 12-20-40420 (1)(b), place on probation any licensed dentist, DENTAL THERAPIST, or21 dental hygienist;22 (3) The board may include, in any disciplinary order that allows23 a dentist, DENTAL THERAPIST, or dental hygienist to continue to practice,24 conditions the board deems appropriate to assure that the dentist, DENTAL25 THERAPIST, or dental hygienist is physically, mentally, and otherwise26 qualified to practice dentistry, DENTAL THERAPY, or dental hygiene in27 219 -18- accordance with generally accepted professional standards of practice.1 The order may include any or all of the following:2 (4) The board may suspend the license of a dentist, DENTAL3 THERAPIST, or dental hygienist who fails to comply with an order of the4 board issued in accordance with this section. The board may impose the5 license suspension until the licensee complies with the board's order.6 (5) (a) In addition to any other penalty permitted under this article7 220, when a licensed dentist, DENTAL THERAPIST, or dental hygienist8 violates a provision of this article 220 or of any rule promulgated9 pursuant to this article 220, the board may impose a fine on the licensee.10 If the licensee is a dentist, the fine must not exceed five thousand dollars.11 I F THE LICENSEE IS A DENTAL THERAPIST, THE FINE MUST NOT EXCEED12 FOUR THOUSAND DOLLARS . If the licensee is a dental hygienist, the fine13 must not exceed three thousand dollars.14 SECTION 11. In Colorado Revised Statutes, 12-220-203, amend15 (1)(a) as follows:16 12-220-203. Disciplinary proceedings. (1) (a) Any person may17 submit a complaint relating to the conduct of a dentist, DENTAL18 THERAPIST, or dental hygienist, which complaint must be in writing and19 signed by the person. The board, on its own motion, may initiate a20 complaint. The board shall notify the dentist, DENTAL THERAPIST, or21 dental hygienist of the complaint against the dentist, DENTAL THERAPIST,22 or dental hygienist.23 SECTION 12. In Colorado Revised Statutes, 12-220-206, amend24 (1) and (2) introductory portion as follows:25 12-220-206. Mental and physical examinations. (1) (a) If the26 board has reasonable cause to believe that a person licensed to practice27 219 -19- dentistry, DENTAL THERAPY, or dental hygiene in this state is unable to1 practice dentistry, DENTAL THERAPY, or dental hygiene with reasonable2 skill and safety to patients because of a physical or mental disability or3 because of excessive use of alcohol, a habit-forming drug or substance,4 or a controlled substance, as defined in section 18-18-102 (5), the board5 may require the licensed dentist, DENTAL THERAPIST, or dental hygienist6 to submit to a mental or physical examination by a qualified professional7 designated by the board.8 (b) Upon the failure of the licensed dentist, DENTAL THERAPIST,9 or dental hygienist to submit to a mental or physical examination required10 by the board, unless the failure is due to circumstances beyond the11 dentist's, DENTAL THERAPIST'S, or dental hygienist's control, the board12 may suspend the dentist's, DENTAL THERAPIST'S, or dental hygienist's13 license to practice dentistry, DENTAL THERAPY, or dental hygiene in this14 state until the dentist, DENTAL THERAPIST, or dental hygienist submits to15 the examination.16 (2) Every person licensed to practice dentistry, DENTAL THERAPY,17 or dental hygiene in this state is deemed, by so practicing or by applying18 for a renewal of the person's license to practice dentistry, DENTAL19 THERAPY, or dental hygiene in this state, to have:20 SECTION 13. In Colorado Revised Statutes, 12-220-208, amend21 (2) as follows:22 12-220-208. Review of board action. (2) The provisions of this23 section apply to a license issued to a dentist, DENTAL THERAPIST, or dental24 hygienist.25 SECTION 14. In Colorado Revised Statutes, 12-220-210, amend26 (1)(a)(I), (2) introductory portion, and (2)(a) as follows:27 219 -20- 12-220-210. Use or sale of forged or invalid diploma, license,1 license renewal certificate, or identification. (1) (a) It is unlawful for2 any person to use or attempt to use:3 (I) As the person's own, a diploma from a dental college or school4 or school of DENTAL THERAPY OR dental hygiene, or a license or license5 renewal certificate, that was issued or granted to another person; or6 (2) It is unlawful to sell or offer to sell a diploma conferring a7 dental, DENTAL THERAPY, or dental hygiene degree or a license or license8 renewal certificate granted pursuant to this article 220 or prior dental9 practice laws, or to procure such diploma or license or license renewal10 certificate:11 (a) With the intent that it be used as evidence of the right to12 practice dentistry, DENTAL THERAPY, or dental hygiene by a person other13 than the one upon whom it was conferred or to whom the license or14 license renewal certificate was granted; or15 SECTION 15. In Colorado Revised Statutes, amend 12-220-21116 as follows:17 12-220-211. Unauthorized practice - penalties. Any person who18 practices or offers or attempts to practice dentistry, DENTAL THERAPY, or19 dental hygiene without an active license issued under this article 220 is20 subject to penalties pursuant to section 12-20-407 (1)(a).21 SECTION 16. In Colorado Revised Statutes, 12-220-301, amend22 (1) introductory portion and (1)(a) as follows:23 12-220-301. Persons entitled to practice dentistry, dental24 therapy, or dental hygiene. (1) It is unlawful for any person to practice25 dentistry, DENTAL THERAPY, or dental hygiene in this state except those:26 (a) Who are duly licensed as dentists, DENTAL THERAPISTS, or27 219 -21- dental hygienists pursuant to this article 220;1 SECTION 17. In Colorado Revised Statutes, 12-220-302, amend2 (1)(c), (1)(e), (1)(f), (1)(i), and (1)(j) as follows:3 12-220-302. Persons exempt from operation of this article.4 (1) This article 220 does not apply to the following practices, acts, and5 operations:6 (c) The practice of dentistry, DENTAL THERAPY, or dental hygiene7 in the discharge of their official duties by graduate dentists, or dental8 surgeons, DENTAL THERAPISTS, or dental hygienists in the United States9 armed forces, public health service, Coast Guard, or veterans10 administration;11 (e) The practice of DENTAL THERAPY OR dental hygiene by12 instructors and students or the practice of dentistry by students or13 residents in schools or colleges of dentistry, schools of DENTAL THERAPY,14 SCHOOLS OF dental hygiene, or schools of dental assistant education while15 the instructors, students, or residents are participating in accredited16 programs of the schools or colleges;17 (f) The practice of dentistry, DENTAL THERAPY, or dental hygiene18 by dentists, DENTAL THERAPISTS, or dental hygienists licensed in good19 standing by other states or countries while appearing in programs of20 dental education or research at the invitation of any group of licensed21 dentists, DENTAL THERAPISTS, or dental hygienists in this state who are in22 good standing, so long as the practice is limited to five consecutive days23 in a twelve-month period and the name of each person engaging in the24 practice is submitted to the board, in writing and on a form approved by25 the board, at least ten days before the person performs the practice;26 (i) The practicing of dentistry, DENTAL THERAPY, or dental27 219 -22- hygiene by an examiner representing a testing agency approved by the1 board, during the administration of an examination; or2 (j) The practice of dentistry, DENTAL THERAPY, or dental hygiene3 by dentists, DENTAL THERAPISTS, or dental hygienists licensed in good4 standing by other states while providing care as a volunteer, at the5 invitation of any group of licensed dentists, DENTAL THERAPISTS, or6 dental hygienists in this state who are in good standing, so long as the7 practice is limited to five consecutive days in a twelve-month period and8 the name of each person engaging in the practice is submitted to the9 board, in writing and on a form approved by the board, at least ten days10 before the person performs the practice.11 SECTION 18. In Colorado Revised Statutes, amend 12-220-30412 as follows:13 12-220-304. Names and status under which dental practice14 may be conducted. (1) The conduct of the practice of dentistry, DENTAL15 THERAPY, or dental hygiene in a corporate capacity is prohibited, but the16 prohibition shall not be construed to prevent the practice of dentistry,17 DENTAL THERAPY, or dental hygiene by a professional service corporation18 of licensees so constituted that they may be treated under the federal19 internal revenue laws as a corporation for tax purposes only. Any such A20 professional service corporation may exercise such THE powers and shall21 be subject to such limitations and requirements, insofar as applicable, as22 are provided in section 12-240-138, relating to professional service23 corporations for the practice of medicine.24 (2) The group practice of dentistry, DENTAL THERAPY, or dental25 hygiene is permitted.26 (3) The practice of dentistry, DENTAL THERAPY, or dental hygiene27 219 -23- by a limited liability company of licensees or by a limited liability1 partnership of licensees is permitted subject to the limitations and2 requirements, insofar as are applicable, set forth in section 12-240-138,3 relating to a limited liability company or limited liability partnership for4 the practice of medicine.5 SECTION 19. In Colorado Revised Statutes, 12-220-305, amend6 (1)(a), (1)(b), (1)(c), (1)(j), (1)(k), (1)(m), (1)(n), (1)(p), and (1)(r) as7 follows:8 12-220-305. What constitutes practicing dentistry - authority9 to electronically prescribe. (1) A person is practicing dentistry if the10 person:11 (a) Performs, or attempts or professes to perform, any dental12 operation, oral surgery, or dental diagnostic or therapeutic services of any13 kind; except that nothing in this subsection (1)(a) prohibits a DENTAL14 THERAPIST, dental hygienist, or dental assistant from providing preventive15 dental or nutritional counseling, education, or instruction services;16 (b) Is a proprietor of a place where dental operation, oral surgery,17 or dental diagnostic or therapeutic services are performed; except that18 nothing in this subsection (1)(b) prohibits a DENTAL THERAPIST, dental19 hygienist, or dental assistant from performing those tasks and procedures20 consistent with section 12-220-501;21 (c) Directly or indirectly, by any means or method, takes22 impression of the human tooth, teeth, jaws, maxillofacial area, or adjacent23 and associated structures; performs any phase of any operation incident24 to the replacement of a part of a tooth; or supplies artificial substitutes for25 the natural teeth, jaws, or adjacent and associated structures; except that26 nothing in this subsection (1)(c) prohibits a DENTAL THERAPIST, dental27 219 -24- hygienist, or dental assistant from performing tasks and procedures1 consistent with sections 12-220-501 (3)(b)(III), and 12-220-503 (1)(d),2 AND 12-220-507;3 (j) Extracts, or attempts to extract, human teeth or corrects, or4 attempts to correct, malformations of human teeth or jaws; EXCEPT THAT 5 THIS SUBSECTION (1)(j) DOES NOT PROHIBIT A DENTAL THERAPIST FROM6 PERFORMING TASKS AND PROCEDURES CONSISTENT WITH SECTION7 12-220-507;8 (k) Repairs or fills cavities in human teeth; EXCEPT THAT THIS 9 SUBSECTION (1)(k) DOES NOT PROHIBIT A DENTAL THERAPIST FROM10 PERFORMING TASKS AND PROCEDURES CONSISTENT WITH SECTION11 12-220-507;12 (m) Gives, or professes to give, interpretations or readings of13 dental X rays or roentgenograms, CT scans, or other diagnostic14 methodologies; except that nothing in this subsection (1)(m) prohibits a15 dental hygienist from performing tasks and procedures consistent with16 sections 12-220-503 and 12-220-504 OR A DENTAL THERAPIST FROM17 PERFORMING TASKS CONSISTENT WITH SECTION 12-220-507;18 (n) Represents himself or herself to an individual or the general19 public as practicing dentistry, by using the words "dentist" or "dental20 surgeon", or by using the letters "D.D.S.", "D.M.D.", "D.D.S./M.D.", or21 "D.M.D./M.D." Nothing in this subsection (1)(n) prohibits a DENTAL22 THERAPIST, dental hygienist, or dental assistant from performing tasks and23 procedures consistent with section 12-220-501 (2), (2.5), or (3)(b).24 (p) Prescribes drugs or medications and administers local25 anesthesia, analgesia including nitrous oxide/oxygen inhalation,26 medication prescribed or administered for the relief of anxiety or27 219 -25- apprehension, minimal sedation, moderate sedation, deep sedation, or1 general anesthesia as necessary for the proper practice of dentistry; except2 that nothing in this subsection (1)(p) prohibits:3 (I) A dental hygienist from performing those tasks and procedures4 consistent with sections 12-220-501, 12-220-503 (1)(e) and (1)(g), and5 12-220-504 (1)(c), and in accordance with rules promulgated by the6 board; OR7 (II) A DENTAL THERAPIST FROM PERFORMING THOSE TASKS AND8 PROCEDURES CONSISTENT WITH SECTIONS 12-220-501 (2.5) AND9 12-220-507, AND IN ACCORDANCE WITH RULES PROMULGATED BY THE10 BOARD.11 (r) Gives or professes to give interpretations or readings of dental12 charts or records or gives treatment plans or interpretations of treatment13 plans derived from examinations, patient records, dental X rays, or14 roentgenograms; except that nothing in this subsection (1)(r) prohibits a15 DENTAL THERAPIST, dental hygienist, or dental assistant from performing16 tasks and procedures consistent with sections 12-220-501 (2), (2.5), and17 (3), 12-220-503, and 12-220-504, AND 12-220-507.18 SECTION 20. In Colorado Revised Statutes, amend 12-220-30719 as follows:20 12-220-307. Professional liability insurance required - rules.21 (1) A licensed dentist, A LICENSED DENTAL THERAPIST, and a licensed22 dental hygienist must meet the financial responsibility requirements23 established by the board pursuant to section 13-64-301 (1)(a).24 (2) Upon request of the board, a licensed dentist, LICENSED25 DENTAL THERAPIST, or licensed dental hygienist shall provide proof of26 professional liability insurance to the board.27 219 -26- (3) The board may, by rule, exempt from or establish lesser1 financial responsibility standards for licensed dentists, LICENSED DENTAL2 THERAPISTS, and licensed dental hygienists who meet the criteria in3 section 13-64-301 (1)(a)(II).4 SECTION 21. In Colorado Revised Statutes, amend 12-220-3085 as follows:6 12-220-308. Continuing education requirements - rules. (1) As7 a condition of renewing, reactivating, or reinstating a license issued under8 this article 220, every dentist, DENTAL THERAPIST, and dental hygienist9 must obtain at least thirty hours of continuing education every two years10 to ensure patient safety and professional competency.11 (2) The board may adopt rules establishing the basic requirements12 for continuing education, including the types of programs that qualify,13 exemptions for persons holding an inactive or retired license,14 requirements for courses designed to enhance clinical skills for certain15 licenses, and the manner by which dentists, DENTAL THERAPISTS, and16 dental hygienists are to report compliance with the continuing education17 requirements.18 SECTION 22. In Colorado Revised Statutes, 12-220-409, amend19 (1), (2)(a), and (5) as follows:20 12-220-409. Inactive dental, dental therapist, or dental21 hygienist license. (1) Any person licensed to practice dentistry, DENTAL22 THERAPY, or dental hygiene pursuant to this article 220 may apply to the23 board to be transferred to an inactive status. The licensee must submit an24 application in the form and manner designated by the board. The board25 may grant inactive status by issuing an inactive license or deny the26 application for any of the causes set forth in section 12-220-201.27 219 -27- (2) Any person applying for a license under this section must:1 (a) Provide an affidavit to the board that the applicant, after a date2 certain, will not practice dentistry, DENTAL THERAPY, or dental hygiene3 in this state unless the applicant is issued a license to practice dentistry,4 DENTAL THERAPY, or dental hygiene pursuant to subsection (5) of this5 section;6 (5) Any person licensed under this section who wishes to resume7 the practice of dentistry, DENTAL THERAPY, or dental hygiene must file an8 application in the form and manner the board designates, pay the license9 fee promulgated by the board pursuant to section 12-20-105, and meet the10 financial responsibility requirements or the professional liability11 insurance requirements established by the board pursuant to sections12 12-220-307 and 13-64-301 (1)(a), as applicable. The board may approve13 the application and issue a license to practice dentistry, DENTAL THERAPY,14 or dental hygiene or may deny the application for any of the causes set15 forth in section 12-220-201.16 SECTION 23. In Colorado Revised Statutes, 12-220-410, amend17 (1), (2)(a), (5), and (6) as follows:18 12-220-410. Retired dental, dental therapist, and dental19 hygienist licenses. (1) Any person licensed to practice dentistry, DENTAL20 THERAPY, or dental hygiene pursuant to this article 220 may apply to the21 board for retired licensure status. The application must be in the form and22 manner designated by the board. The board may grant retired licensure23 status by issuing a retired license, or it may deny the application if the24 licensee has been disciplined for any of the causes set forth in section25 12-220-201.26 (2) Any person applying for a license under this section must:27 219 -28- (a) Provide an affidavit to the board stating that, after a date1 certain, the applicant will not practice dentistry, DENTAL THERAPY, or2 dental hygiene; will no longer earn income as a dentist, DENTAL3 THERAPIST, or dental hygiene administrator or consultant; and will not4 perform any activity that constitutes practicing dentistry, DENTAL5 THERAPY, or dental hygiene pursuant to sections 12-220-305, 12-220-501,6 12-220-503, and 12-220-504, AND 12-220-507 unless the applicant is7 issued a license to practice dentistry, DENTAL THERAPY, or dental hygiene8 pursuant to subsection (5) of this section; and9 (5) Any person licensed under this section may apply to the board10 for a return to active licensure status by filing an application in the form11 and manner the board designates, paying the appropriate license fee12 established pursuant to section 12-20-105, and meeting the financial13 responsibility requirements or the professional liability insurance14 requirements established by the board pursuant to sections 12-220-30715 and 13-64-301 (1)(a), as applicable. The board may approve the16 application and issue a license to practice dentistry, DENTAL THERAPY, or17 dental hygiene or may deny the application if the licensee has been18 disciplined for any of the causes set forth in section 12-220-201.19 (6) A dentist, DENTAL THERAPIST, or dental hygienist on retired20 status may provide dental, DENTAL THERAPY, or dental hygiene services21 on a voluntary basis to the PEOPLE WHO ARE indigent if the retired dentist,22 DENTAL THERAPIST, or dental hygienist provides the services on a limited23 basis and does not charge a fee for the services. A retired dentist, DENTAL24 THERAPIST, or dental hygienist providing voluntary care pursuant to this25 subsection (6) is immune from any liability resulting from the voluntary26 care the retired dentist, DENTAL THERAPIST, or dental hygienist provided.27 219 -29- SECTION 24. In Colorado Revised Statutes, 12-220-411, amend1 (1), (3), and (4)(a); and add (6) as follows:2 12-220-411. Anesthesia and sedation permits - dentists, dental3 therapists, and dental hygienists - training and experience4 requirements - office inspections - rules. (1) Upon application in a5 form and manner determined by the board and payment of the applicable6 fees established by the board, the board may issue an anesthesia or7 sedation permit to a licensed dentist or a local anesthesia permit to a8 DENTAL THERAPIST OR dental hygienist in accordance with this section.9 (3) (a) A licensed DENTAL THERAPIST OR dental hygienist who10 obtains a local anesthesia permit pursuant to this section may administer11 local anesthesia.12 (b) A local anesthesia permit issued to a DENTAL THERAPIST OR13 dental hygienist is valid as long as the DENTAL THERAPIST'S OR dental14 hygienist's license is active.15 (4) (a) The board shall establish, by rule, minimum training,16 experience, and equipment requirements for the administration of local17 anesthesia, analgesia including nitrous oxide/oxygen inhalation, and18 medication prescribed or administered for the relief of anxiety or19 apprehension, minimal sedation, moderate sedation, deep sedation, or20 general anesthesia, including procedures that may be used by and21 minimum training requirements for dentists, DENTAL THERAPISTS, dental22 hygienists, and dental assistants.23 (6) F OR THE PURPOSES OF THIS SECTION, A DENTAL THERAPIST24 WHO PERFORMS A TASK PURSUANT TO A WRITTEN ARTICULATED PLAN25 THAT MEETS THE REQUIREMENTS OF SECTION 12-220-507 (2) IS26 CONSIDERED TO HAVE PERFORMED THE TASK WITH THE PRIOR KNOWLEDGE27 219 -30- AND CONSENT OF THE DENTIST.1 SECTION 25. In Colorado Revised Statutes, 12-220-601, amend2 (1) and (2) as follows:3 12-220-601. Legislative declaration. (1) The general assembly4 hereby finds, determines, and declares that public exposure to the hazards5 of ionizing radiation used for diagnostic purposes should be minimized6 wherever possible. Accordingly, the general assembly finds, determines,7 and declares that for any dentist, DENTAL THERAPIST, or dental hygienist8 to allow an untrained person to operate a machine source of ionizing9 radiation, including without limitation a device commonly known as an10 "X-ray machine", or to administer radiation to a patient for diagnostic11 purposes is a threat to the public health and safety.12 (2) It is the intent of the general assembly that dentists, DENTAL13 THERAPISTS, and dental hygienists utilizing unlicensed persons in their14 practices provide those persons with a minimum level of education and15 training before allowing them to operate machine sources of ionizing16 radiation; however, it is not the general assembly's intent to discourage17 education and training beyond this minimum. It is further the intent of the18 general assembly that established minimum training and education19 requirements correspond as closely as possible to the requirements of20 each particular work setting as determined by the board pursuant to this21 part 6.22 SECTION 26. In Colorado Revised Statutes, 12-220-602, amend23 (1) and (2) as follows:24 12-220-602. Minimum standards - rules - definition.25 (1) (a) The board shall adopt rules prescribing minimum standards for the26 qualifications, education, and training of unlicensed persons operating27 219 -31- machine sources of ionizing radiation and administering radiation to1 patients for diagnostic medical use. A licensed dentist, DENTAL2 THERAPIST, or dental hygienist shall not allow an unlicensed person to3 operate a machine source of ionizing radiation or to administer radiation4 to any patient unless the person meets standards then in effect under rules5 adopted pursuant to this section. The board may adopt rules allowing a6 grace period in which newly hired operators of machine sources of7 ionizing radiation are to receive the training required by this section.8 (b) For purposes of AS USED IN this part 6, "unlicensed person"9 means a person who does not hold a current and active license entitling10 the person to practice dentistry, DENTAL THERAPY, or dental hygiene11 under this article 220.12 (2) The board shall seek the assistance of licensed dentists,13 DENTAL THERAPISTS, or licensed dental hygienists in developing and14 formulating the rules promulgated pursuant to this section.15 SECTION 27. In Colorado Revised Statutes, 12-20-202, add16 (3)(e)(IX.5) as follows:17 12-20-202. Licenses, certifications, and registrations - renewal18 - reinstatement - fees - occupational credential portability program19 - temporary authority for military spouses - exceptions for military20 personnel - rules - consideration of criminal convictions or driver's21 history - executive director authority - definitions. (3) Occupational22 credential portability program. (e) Subsections (3)(a) to (3)(d) of this23 section do not apply to the following professions or occupations:24 (IX.5) D ENTAL THERAPISTS, REGULATED PURSUANT TO ARTICLE25 220 OF THIS TITLE 12; 26 SECTION 28. In Colorado Revised Statutes, 12-20-406, amend27 219 -32- (3)(f) as follows:1 12-20-406. Injunctive relief. (3) This section does not apply to2 the following:3 (f) Article 220 of this title 12 concerning dentists, DENTAL4 THERAPISTS, and dental hygienists;5 SECTION 29. In Colorado Revised Statutes, 12-20-407, amend6 (1)(a)(V)(J) as follows:7 12-20-407. Unauthorized practice of profession or occupation8 - penalties - exclusions. (1) (a) A person commits a class 2 misdemeanor9 and shall be punished as provided in section 18-1.3-501 if the person:10 (V) Practices or offers or attempts to practice any of the following11 professions or occupations without an active license, certification, or12 registration issued under the part or article of this title 12 governing the13 particular profession or occupation:14 (J) Dentistry, DENTAL THERAPY, or dental hygiene, as regulated15 under article 220 of this title 12;16 SECTION 30. In Colorado Revised Statutes, 12-30-102, amend17 (3)(a)(VII) as follows:18 12-30-102. Medical transparency act of 2010 - disclosure of19 information about health-care providers - fines - rules - short title -20 legislative declaration - review of functions - repeal. (3) (a) As used21 in this section, "applicant" means a person applying for a new, active22 license, certification, or registration or to renew, reinstate, or reactivate23 an active license, certification, or registration to practice:24 (VII) Dental THERAPY OR DENTAL hygiene pursuant to article 22025 of this title 12;26 SECTION 31. In Colorado Revised Statutes, 12-30-103, amend27 219 -33- (4)(a)(IV) as follows:1 12-30-103. Solicitation of accident victims - waiting period -2 definitions. (4) As used in this section:3 (a) "Health-care practitioner" means:4 (IV) A dentist, DENTAL THERAPIST, or dental hygienist licensed5 under article 220 of this title 12;6 SECTION 32. In Colorado Revised Statutes, 13-4-102, amend7 (1)(g) and (2)(g) as follows:8 13-4-102. Jurisdiction. (1) Any provision of law to the contrary9 notwithstanding, the court of appeals shall have initial jurisdiction over10 appeals from final judgments of, and interlocutory appeals of certified11 questions of law in civil cases pursuant to section 13-4-102.1 from, the12 district courts, the probate court of the city and county of Denver, and the13 juvenile court of the city and county of Denver, except in:14 (g) Review actions of the Colorado dental board in refusing to15 issue or renew or in suspending or revoking a license to practice dentistry,16 DENTAL THERAPY, or dental hygiene, as provided in section 12-220-208;17 (2) The court of appeals has initial jurisdiction to:18 (g) Review actions of the Colorado dental board in refusing to19 issue or renew or in suspending or revoking a license to practice dentistry,20 DENTAL THERAPY, or dental hygiene, as provided in section 12-220-137 21 SECTION 12-220-208;22 SECTION 33. In Colorado Revised Statutes, 13-21-115.5,23 amend (3)(c)(II)(R) as follows:24 13-21-115.5. Volunteer service act - immunity - exception for25 operation of motor vehicles - short title - legislative declaration -26 definitions. (3) As used in this section, unless the context otherwise27 219 -34- requires:1 (c) (II) "Volunteer" includes:2 (R) A licensed dentist, DENTAL THERAPIST, or dental hygienist3 governed by article 220 of title 12 performing the practice of dentistry,4 DENTAL THERAPY, or dental hygiene, as defined in section 12-220-1045 and as described in section SECTIONS 12-220-305, 12-220-402,6 12-220-403, AND 12-220-507; as a volunteer for a nonprofit organization,7 nonprofit corporation, governmental entity, or hospital; or a dentist,8 DENTAL THERAPIST, or dental hygienist who holds a license in good9 standing from another state performing the practice of dentistry, DENTAL10 THERAPY, or dental hygiene, as defined in section 12-220-104 and as11 described in section SECTIONS 12-220-305, 12-220-402, 12-220-403, AND12 12-220-507, as a volunteer for a nonprofit organization, nonprofit13 corporation, governmental entity, or hospital pursuant to section14 12-220-302 (1)(j); and15 SECTION 34. In Colorado Revised Statutes, 13-64-301, amend16 (1) introductory portion, (1)(a)(I), (1)(a)(II) introductory portion,17 (1)(a)(III), and (1)(a)(IV) as follows:18 13-64-301. Financial responsibility. (1) As a condition of active19 licensure or authority to practice in this state, every physician, dentist,20 DENTAL THERAPIST, or dental hygienist; every physician assistant who has21 been practicing for at least three years; and every health-care institution22 as defined in section 13-64-202, except as provided in section23 13-64-303.5, that provides health-care services shall establish financial24 responsibility, as follows:25 (a) (I) (A) If a dentist, by maintaining commercial professional26 liability insurance coverage with an insurance company authorized to do27 219 -35- business in this state or an eligible nonadmitted insurer allowed to insure1 in Colorado pursuant to article 5 of title 10, C.R.S., in a minimum2 indemnity amount of five hundred thousand dollars per incident and one3 million five hundred thousand dollars annual aggregate per year; except4 that this requirement is not applicable to a dentist who is a public5 employee under the "Colorado Governmental Immunity Act", article 106 of title 24. C.R.S.7 (B) A licensed dental hygienist must have MAINTAIN professional8 liability insurance in an amount not less than fifty thousand dollars per9 claim and with an aggregate liability limit for all claims during a calendar10 year of not less than three hundred thousand dollars; except that this11 requirement does not apply to a licensed dental hygienist who is a public12 employee under the "Colorado Governmental Immunity Act", article 1013 of title 24. C.R.S.14 (C) A LICENSED DENTAL THERAPIST MUST MAINTAIN15 PROFESSIONAL LIABILITY INSURANCE IN AN AMOUNT NOT LESS THAN FIVE16 HUNDRED THOUSAND DOLLARS PER INCIDENT AND ONE MILLION FIVE17 HUNDRED THOUSAND DOLLARS ANNUAL AGGREGATE PER YEAR ; EXCEPT18 THAT THIS REQUIREMENT IS NOT APPLICABLE TO A DENTAL THERAPIST19 WHO IS A PUBLIC EMPLOYEE UNDER THE "COLORADO GOVERNMENTAL20 I MMUNITY ACT", ARTICLE 10 OF TITLE 24.21 (II) The Colorado dental board, by rule, may exempt from or22 establish lesser financial responsibility standards than those prescribed in23 this section for classes of LICENSED dentists, and licensed DENTAL24 THERAPISTS, AND dental hygienists who:25 (III) The Colorado dental board may exempt from or establish26 lesser financial responsibility standards for a LICENSED dentist, DENTAL27 219 -36- THERAPIST, or licensed dental hygienist for reasons other than those1 described in subparagraph (II) of this paragraph (a) SUBSECTION (1)(a)(II)2 OF THIS SECTION that render the limits provided in subparagraph (I) of this3 paragraph (a) SUBSECTION (1)(a)(I) OF THIS SECTION unreasonable or4 unattainable.5 (IV) Nothing in this paragraph (a) SUBSECTION (1)(a) shall6 preclude or otherwise prohibit a licensed dentist, DENTAL THERAPIST, or7 licensed dental hygienist from rendering appropriate patient care on an8 occasional basis when the circumstances surrounding the need for care so9 warrant.10 SECTION 35. In Colorado Revised Statutes, 19-3-304, amend11 (2)(o) as follows: 12 19-3-304. Persons required to report child abuse or neglect.13 (2) Persons required to report such abuse or neglect or circumstances or14 conditions include any:15 (o) Dental THERAPIST OR DENTAL hygienist;16 SECTION 36. In Colorado Revised Statutes, add 23-5-148 as17 follows:18 23-5-148. Dental therapy training programs - authorization to19 grant advanced standing - definition. (1) A S USED IN THIS SECTION,20 " STATE INSTITUTION OF HIGHER EDUCATION " HAS THE SAME MEANING AS21 SET FORTH IN SECTION 23-18-102 (10)(a).22 (2) A STATE INSTITUTION OF HIGHER EDUCATION OFFERING AN23 ACCREDITED DENTAL THERAPY TRAINING PROGRAM MAY GRANT24 ADVANCED STANDING TOWARD COMPLETION OF AN ACCREDITED DENTAL25 THERAPY PROGRAM IF A STUDENT DEMONSTRATES PAST COMPLETION OF26 CURRICULUM THAT MEETS OR EXCEEDS THE CONTENT STANDARDS FOR27 219 -37- ONE OR MORE COURSES THAT COMPRISE THE DENTAL THERAPY1 CURRICULUM ACCREDITED BY THE AMERICAN DENTAL ASSOCIATION'S2 COMMISSION ON DENTAL ACCREDITATION , OR ITS SUCCESSOR3 ORGANIZATION.4 SECTION 37. In Colorado Revised Statutes, 25-1-108.7, amend5 (3)(f) as follows:6 25-1-108.7. Health care credentials uniform application act -7 legislative declaration - definitions - state board of health rules.8 (3) As used in this section, unless the context otherwise requires:9 (f) "Health-care professional" means a physician, dentist, DENTAL10 THERAPIST, dental hygienist, chiropractor, podiatrist, psychologist,11 advanced practice REGISTERED nurse, optometrist, physician assistant,12 licensed clinical social worker, child health associate, marriage and13 family therapist, or other health-care professional who is registered,14 certified, or licensed pursuant to title 12; C.R.S.; who is subject to15 credentialing; and who practices, or intends to practice, in Colorado.16 SECTION 38. In Colorado Revised Statutes, 25-1-1202, amend17 (1)(k) as follows:18 25-1-1202. Index of statutory sections regarding medical19 record confidentiality and health information. (1) Statutory provisions20 concerning policies, procedures, and references to the release, sharing,21 and use of medical records and health information include the following:22 (k) Section 12-220-201, concerning disciplinary actions against23 dentists, DENTAL THERAPISTS, and dental hygienists;24 SECTION 39. In Colorado Revised Statutes, amend 25.5-4-411 25 as follows:26 25.5-4-411. Authorization of services provided by dental27 219 -38- hygienists. (1) When dental hygiene services are provided to children by1 a licensed dental hygienist OR DENTAL THERAPIST who is providing dental 2 hygiene services pursuant to section 12-220-503 without the supervision3 of a licensed dentist, the executive director of the state department shall4 authorize reimbursement for said services, subject to the requirements of5 this section. Payment for the services shall be made directly to the6 licensed dental hygienist OR DENTAL THERAPIST, if requested by the 7 licensed dental hygienist OR DENTAL THERAPIST; except that this section 8 shall DOES not apply to licensed dental hygienists OR DENTAL THERAPISTS9 when acting within the scope of their employment as salaried employees10 of public or private institutions, physicians, or dentists.11 (2) For each child provided dental hygiene services pursuant to12 this section, the dental hygienist OR DENTAL THERAPIST shall attempt to 13 identify a dentist participating in medicaid for the child.14 SECTION 40. Appropriation. (1) For the 2022-23 state fiscal15 year, $14,786 is appropriated to the department of regulatory agencies.16 This appropriation is from the division of professions and occupations17 cash fund created in section 12-20-105 (3), C.R.S. To implement this act,18 the department may use this appropriation for the purchase of legal19 services.20 (2) For the 2022-23 state fiscal year, $14,786 is appropriated to21 the department of law. This appropriation is from reappropriated funds22 received from the department of regulatory agencies under subsection (1)23 of this section and is based on an assumption that the department of law24 will require an additional 0.1 FTE. To implement this act, the department25 of law may use this appropriation to provide legal services for the26 department of regulatory agencies.27 219 -39- SECTION 41. Act subject to petition - effective date -1 applicability. (1) This act takes effect January 1, 2023; except that, if a2 referendum petition is filed pursuant to section 1 (3) of article V of the3 state constitution against this act or an item, section, or part of this act4 within the ninety-day period after final adjournment of the general5 assembly, then the act, item, section, or part will not take effect unless6 approved by the people at the general election to be held in November7 2022 and, in such case, will take effect January 1, 2023, or on the date of8 the official declaration of the vote thereon by the governor, whichever is9 later.10 (2) This act applies to the practice of dental therapy on or after the11 applicable effective date of this act.12 219 -40-