First Regular Session Seventy-fifth General Assembly STATE OF COLORADO REENGROSSED This Version Includes All Amendments Adopted in the House of Introduction LLS NO. 25-0401.03 Kristen Forrestal x4217 SENATE BILL 25-194 Senate Committees House Committees Health & Human Services Appropriations A BILL FOR AN ACT C ONCERNING THE CONTINUATION OF THE "DENTAL PRACTICE ACT".101 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 .) Sunset Process - Senate Health and Human Services Committee. The bill makes changes to the "Dental Practice Act" (act) by: ! Continuing the act for 9 years, until 2034; ! Updating and adding definitions; ! Changing the makeup of the Colorado dental board (board); ! Requiring the attorney general, in addition to counseling the board, to counsel and advise the board's consultants; SENATE Amended 3rd Reading April 17, 2025 SENATE Amended 2nd Reading April 15, 2025 SENATE SPONSORSHIP Michaelson Jenet and Mullica, Cutter, Frizell, Bridges, Exum, Gonzales J., Roberts HOUSE SPONSORSHIP Duran and Hartsook, Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment. Capital letters or bold & italic numbers indicate new material to be added to existing law. Dashes through the words or numbers indicate deletions from existing law. ! Adding and updating the grounds for which the board may take disciplinary action against an applicant for licensure or a licensee; ! Allowing a licensee's submission to a mental or physical examination to satisfy the requirement to notify the board of a condition that would impair the licensee's ability to practice; ! Adding as exemptions to the act the volunteer practice of dentistry and dental hygiene under specific conditions; ! Repealing the exceptions that allow a dental therapist, dental hygienist, or dental assistant to perform certain dentistry practices and including additional tasks to the list of items included in the practice of dentistry; ! Clarifying that a dental assistant, dental hygienist, and dental therapist may perform tasks consistent with rules adopted by the board; ! Requiring providers who perform itinerant surgery to develop and maintain protocols for emergency follow-up care; ! Authorizing licensed dentists to prescribe orders electronically; ! Requiring a peer health assistance program selected as a designated provider for the dentist peer health assistance program to provide training and calibration to dentists who practice monitoring services; ! Authorizing dentists to self-refer to participate in a peer health assistance program or be referred by the board; ! Requiring an applicant for dental, dental hygienist, or dental therapy licensure to pass a jurisprudence examination that tests the applicant's knowledge of the act; ! Removing a requirement that dental education schools and programs must be accredited or approved by a specific entity; ! Requiring the board to adopt rules that allow for expedited, temporary licensure during a public health emergency; ! Repealing specific tasks that are currently authorized to be performed by a dental therapist; ! Updating procedures for the construction of dental devices by an unlicensed technician; ! Updating the list of practices that are considered to be the practice of unsupervised dental hygiene; ! Repealing the specific dosages of certain drugs that a dental hygienist may prescribe; ! Authorizing the board to adopt rules that identify safe prescribing alternatives to silver diamine fluoride as a 194 -2- treatment for strengthening teeth and preventing tooth decay; ! Identifying tasks that are deemed to be practicing supervised dental hygiene; ! Requiring a dental hygienist performing an interim therapeutic restoration to confirm a referral for follow-up care with a dentist; ! Limiting the number of dental hygienists that a dentist may supervise; and ! Authorizing a dental therapist to perform specific tasks. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. In Colorado Revised Statutes, 12-220-104, amend2 (1), (4), (9)(a), and (10)(a); add (5.2), (10.5), and (14.5); and add with3 amended and relocated provisions (5.3) as follows:4 12-220-104. Definitions - rules. As used in this article 220, unless5 the context otherwise requires:6 (1) "Accredited" means a program that is nationally recognized for7 specialized accrediting for dental, dental therapy, dental hygiene, and8 dental auxiliary programs by THE COMMISSION ON DENTAL9 A CCREDITATION OR A SPECIALTY ACCREDITING ORGANIZATION10 RECOGNIZED BY the United States department of education OR BY A11 SUCCESSOR ORGANIZATION OF THE COMMISSION . 12 (4) "Dental hygiene" means the delivery of preventive,13 educational, and clinical services supporting total health for the control14 of oral disease; THE IMPACT OF THE DISEASE, DISORDER, OR CONDITION ON15 THE HUMAN BODY; and the promotion of oral health provided by a dental16 hygienist within the scope of the dental hygienist's education, training,17 and experience and in accordance with applicable law.18 (5.2) "D ENTAL HYGIENE LABORATORY WORK ORDER " MEANS THE 19 DOCUMENTED ORDER OF A DENTAL HYGIENIST LICENSED IN THIS STATE20 194-3- AUTHORIZING ANOTHER PERSON TO CONSTRUCT , REPRODUCE, OR REPAIR1 AN ORAL MEDICAMENT CARRIER .2 (5.3) [Formerly 12-220-104 (11)] "D ENTAL laboratory work 3 order" means the written instructions DOCUMENTED ORDER of a dentist4 licensed in Colorado authorizing another person to construct, reproduce,5 or repair any prosthetic denture, bridge, appliance, or other structure to6 function in the oral cavity, maxillofacial area, or adjacent and associated7 regions.8 (9) (a) (I) "Indirect supervision" means the supervision of those9 tasks or procedures that do not require the presence of the dentist in the10 office or on the premises at the time the tasks or procedures are being11 performed but do require that the tasks be performed with the prior12 knowledge and consent of the dentist.13 (II) F OR PROCEDURES PERFORMED UNDER INDIRECT SUPERVISION , 14 IF FOLLOW-UP CARE IS INDICATED, THE TREATING PROVIDER SHALL15 PROVIDE AN APPROPRIATE REFERRAL FOR RECOMMENDED FOLLOW -UP16 CARE.17 (III) A DENTIST WHO PROVIDES INDIRECT SUPERVISION MUST HAVE18 AN ACTIVE COLORADO LICENSE IN GOOD STANDING .19 (10) (a) "Interim therapeutic restoration" or "ITR" means a direct20 provisional restoration placed to stabilize a tooth until a licensed dentist21 OR DENTAL THERAPIST can assess the need for further definitive treatment.22 (10.5) "ITINERANT SURGERY" MEANS THE PROVISION OF23 ELECTIVE SURGICAL PROCEDURES BY A PROVIDER WHO TRAVELS BETWEEN24 MULTIPLE TREATMENT FACILITIES RATHER THAN OPERATING FROM A25 SINGLE, ESTABLISHED SURGICAL LOCATION WHERE THE PROVIDER IS NOT26 EMPLOYED OR DOES NOT HOLD OWNERSHIP OR A LONG -TERM LEASE.27 194 -4- "ITINERANT SURGERY" INCLUDES SPECIALTY-LEVEL SURGICAL CARE1 PERFORMED IN A FACILITY BY A PROVIDER WHO IS NOT A GRADUATE OF AN2 ACCREDITED SURGICAL TRAINING PROGRAM FOR THAT SPECIALTY .3 (14.5) "TELEDENTISTRY" MEANS TELEHEALTH METHODOLOGIES4 AND SYSTEMS THAT ARE USED IN A MANNER THAT IS COMPLIANT WITH THE5 FEDERAL "HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT6 OF 1996", 42 U.S.C. SECS. 1320d TO 1320d-9, AS AMENDED, TO DELIVER7 ORAL HEALTH SERVICES IN DENTISTRY, INCLUDING INFORMATIONAL AND8 ELECTRONIC COMMUNICATION TECHNOLOGIES , REMOTE MONITORING9 TECHNOLOGIES, AND STORE-AND-FORWARD TRANSFERS, TO FACILITATE10 THE ASSESSMENT, DIAGNOSIS, CONSULTATION, COUNSELING, AND11 EDUCATION OF, OR TREATMENT PLANNING FOR , A PATIENT WHILE THE12 PATIENT IS LOCATED AT AN ORIGINATING SITE WITHOUT A DENTAL13 PRACTITIONER, AND THE DENTAL PRACTITIONER PROVIDING THE SERVICE14 IS AT A DISTANT SITE.15 16 SECTION 2. In Colorado Revised Statutes, 12-220-105, amend17 (1)(b)(II)(A) and (5) as follows:18 12-220-105. Colorado dental board - qualifications of board19 members - quorum - panel - rules - review of functions - repeal of20 article - repeal. (1) (b) (II) (A) Effective July 1, 2031, the board consists21 of seven dentist members, two ONE OF WHOM IS AN ORAL AND22 MAXILLOFACIAL SURGEON UNLESS AN ORAL AND MAXILLOFACIAL23 SURGEON IS NOT AVAILABLE; ONE dental therapist members, two MEMBER;24 THREE dental hygienist members; and two members from the public at25 large; EXCEPT THAT THE DENTAL THERAPIST SEAT SHALL REMAIN OPEN 26 AND A DENTAL THERAPIST MEMBER SHALL NOT BE APPOINTED UNTIL27 194 -5- THERE ARE AT LEAST ONE HUNDRED DENTAL THERAPISTS ACTIVELY1 ENGAGED IN CLINICAL PRACTICE IN THIS STATE . The governor shall2 appoint each member for a term of four years, and each member must3 have the qualifications provided in this article 220. A member shall not4 serve more than two consecutive terms of four years. Each board member5 holds office until the member's term expires or until the governor6 appoints a successor.7 (5) (a) THIS ARTICLE 220 IS REPEALED, EFFECTIVE SEPTEMBER 1,8 2034. Before the repeal, of this article 220 pursuant to subsection (5)(b)9 of this section, all functions of the board are scheduled for review in10 accordance with section 24-34-104.11 (b) This article 220 is repealed, effective September 1, 2025.12 SECTION 3. In Colorado Revised Statutes, 12-220-106, amend13 (1)(a) introductory portion and (2); and add (1)(a)(VI) and (1)(a)(VII) as14 follows:15 12-220-106. Powers and duties of board - rules - limitation on16 authority. (1) The board shall exercise, in accordance with this article17 220, the following powers and duties:18 (a) Make ADOPT, publish, declare, and periodically review19 reasonable rules pursuant to section 12-20-204, including rules regarding:20 (VI) R EQUIREMENTS FOR JURISPRUDENCE EDUCATION PRIOR TO 21 INITIAL LICENSURE;22 (VII) D EFINITIONS FOR THE TERMS "IN GOOD STANDING" AND 23 " PATIENT REPRESENTATIVE" FOR THE PURPOSES OF THIS ARTICLE 220; 24 (2) The board may recognize those dental specialties defined by25 the American Dental Association NATIONAL COMMISSION ON26 R ECOGNITION OF DENTAL SPECIALTIES AND CERTIFYING BOARDS OR THE27 194 -6- UNITED STATES DEPARTMENT OF EDUCATION .1 SECTION 4. In Colorado Revised Statutes, amend 12-220-1082 as follows:3 12-220-108. Attorney general shall represent board and4 members. (1) The attorney general of the state of Colorado shall counsel5 with and advise the board in connection with its THE BOARD'S duties6 and responsibilities under DESCRIBED IN this article 220. If litigation is7 brought against the board or any of its individual members in8 connection with actions taken by the board or any of its members under9 this article 220 and the actions are free of malice, fraud, or willful neglect10 of duty, the attorney general shall defend the litigation without cost to the11 board or to any individual member of the board.12 (2) A WITNESS OR CONSULTANT APPEARING OR TESTIFYING BEFORE 13 THE BOARD, OR PROVIDING EXPERT CONSULTATION TO THE BOARD , HAS14 THE SAME IMMUNITY AND IS SUBJECT TO THE SAME C ONDITIONS FOR15 IMMUNITY AS SPECIFIED IN SECTION 12-20-402.16 SECTION 5. In Colorado Revised Statutes, 12-220-201, amend17 (1)(n), (1)(s), (1)(ii), and (1)(oo); and add (1)(qq) and (1)(rr) as follows:18 12-220-201. Grounds for disciplinary action - definition.19 (1) The board may take disciplinary action against an applicant or20 licensee in accordance with sections 12-20-404 and 12-220-202 for any21 of the following causes:22 (n) Refusing to make patient records available to a patient,23 PATIENT REPRESENTATIVE , OR PREVIOUS OR CURRENT TREATMENT24 PROVIDER WITHIN SEVEN CALENDAR DAYS AFTER A WRITTEN REQUEST25 pursuant to a written authorization request under section 25-1-802;26 (s) Failing to furnish unlicensed persons with DENTAL laboratory27 194 -7- work orders pursuant to section 12-220-502;1 (ii) Advertising or otherwise holding oneself out to the public as2 practicing a dental specialty in which the dentist has not successfully3 completed the education specified for the dental specialty as defined by4 the American Dental Association NATIONAL COMMISSION ON5 R ECOGNITION OF DENTAL SPECIALTIES AND CERTIFYING BOARDS OR THE6 U NITED STATES DEPARTMENT OF EDUCATION ;7 (oo) Failing to comply with sections 12-220-501 (1)(a)(II)(C) and 8 12-220-503 (1)(g) SECTION 12-220-503 (1)(g) and rules adopted pursuant9 to those sections THAT SECTION regarding the application of silver10 diamine fluoride; or11 (qq) P RACTICING OUTSIDE THE SCOPE OF AN ARTICULATED PLAN12 DEVELOPED IN ACCORDANCE WITH SECTION 12-220-503 (1)(g)(V) OR 13 12-220-508 (1)(b), (1)(c)(VII), OR (2); OR14 (rr) T HE FAILURE OF THE PROVIDER PERFORMING ITINERANT 15 SURGERY TO PROVIDE NECESSARY FOLLOW -UP CARE, INCLUDING THE16 FAILURE TO PROVIDE A POST -PROCEDURE CARE PLAN OUTLINING17 FOLLOW-UP CARE IN A FACILITY OR TO BE PERFORMED BY A LICENSED18 SURGICAL SPECIALIST WHO IS LOCATED WITHIN A REASONABLE DISTANCE19 FROM THE OFFICE WHERE THE INITIAL CARE WAS PROVIDED IF THE20 ORIGINAL ITINERANT CARE PROVIDER IS UNAVAILABLE TO PROVIDE THE21 NECESSARY FOLLOW-UP CARE. THE POST-PROCEDURE CARE PLAN SHALL22 NOT IDENTIFY AN URGENT CARE CENTER OR A HOSPITAL EMERGENCY23 DEPARTMENT AS THE PROVIDER OR THE TREATMENT FACILITY FOR24 FOLLOW-UP CARE.25 SECTION 6. In Colorado Revised Statutes, 12-220-206, add (4)26 and (5) as follows:27 194 -8- 12-220-206. Mental and physical examinations. (4) A1 LICENSEE'S VOLUNTARY SUBMISSION TO A MENTAL OR PHYSICAL2 EXAMINATION AND COMPLETION OF ANY REQUIREMENTS GIVEN BY THE3 QUALIFIED PROFESSIONAL DESIGNATED BY THE BOARD SATISFIES ANY4 REQUIREMENT TO NOTIFY THE BOARD OF A PHYSICAL OR MENTAL HEALTH5 CONDITION THAT MAY IMPACT THE LICENSEE 'S ABILITY TO PRACTICE WITH6 REASONABLE SKILL AND SAFETY PURSUANT TO SECTION 12-30-108 (1),7 12-220-201 (1)(j)(I), OR 12-220-310 (3), UNLESS THE QUALIFIED 8 PROFESSIONAL NOTIFIES THE LICENSEE THAT THE LICENSEE MUST NOTIFY9 THE BOARD OF THE CONDITION.10 (5) N OTIFICATION REQUIREMENTS DESCRIBED IN SECTION11 12-30-108 (1), 12-220-201 (1)(j)(I), OR 12-220-310 (3) BEGIN UPON12 DISCHARGE OF A LICENSEE ENROLLED IN INPATIENT TREATMENT FOR A13 SERIOUS MENTAL HEALTH OR PHYSICAL CONDITION .14 SECTION 7. In Colorado Revised Statutes, 12-220-302, amend15 (1)(b), (1)(f), (1)(g), and (1)(j); and add (1)(k) and (1)(l) as follows:16 12-220-302. Persons exempt from operation of this article.17 (1) This article 220 does not apply to the following practices, acts, and18 operations:19 (b) The administration of an anesthetic FOR A DENTAL OPERATION20 by a qualified anesthetist LICENSED PURSUANT TO ARTICLE 240 OF THIS21 TITLE 12 or registered A nurse for a dental operation LICENSED OR22 REGISTERED PURSUANT TO ARTICLE 255 OF THIS TITLE 12;23 (f) The practice of dentistry, dental therapy, or dental hygiene by24 dentists, dental therapists, or dental hygienists licensed in good standing25 by other states or countries while appearing in ACCREDITED OR26 BOARD-APPROVED programs of dental education or research, at the27 194 -9- invitation of any group of licensed dentists, dental therapists, or dental1 hygienists in this state who are in good standing, so long as the practice2 is limited to five consecutive days in a twelve-month period and the name3 of each person engaging in the practice is submitted to the board, in4 writing and on a form A FORMAT approved by the board, at least ten days5 before the person performs the practice;6 (g) The filling of DENTAL laboratory work orders of a licensed7 dentist, as provided by section 12-220-502, by any person, association,8 corporation, or other entity for the construction, reproduction, or repair9 of prosthetic dentures, bridges, plates, or appliances to be used or worn10 as substitutes for natural teeth or for restoration of natural teeth, or11 replacement of structures relating to the jaws, maxillofacial area, or12 adjacent and associated structures;13 (j) The practice of dentistry dental therapy, or dental hygiene by14 dentists dental therapists, or dental hygienists licensed in good standing15 by other states while providing care as a volunteer, at the invitation of any16 group of licensed dentists, dental therapists, or dental hygienists in this17 state who are in good standing, so long as the practice is limited to five18 consecutive days in a twelve-month period and the name of each person19 engaging in the practice is submitted to the board, in writing and on a20 form A FORMAT approved by the board, at least ten days before the person21 performs the practice;22 (k) T HE PRACTICE OF DENTAL THERAPY BY DENTAL THERAPISTS23 LICENSED IN GOOD STANDING BY OTHER STATES WHILE PROVIDING CARE24 AS A VOLUNTEER, AT THE INVITATION OF ANY GROUP OF LICENSED25 DENTISTS, DENTAL THERAPISTS, OR DENTAL HYGIENISTS IN THIS STATE26 WHO ARE IN GOOD STANDING , SO LONG AS THE PRACTICE IS LIMITED TO27 194 -10- FIVE CONSECUTIVE DAYS IN A TWELVE-MONTH PERIOD AND THE NAME OF1 EACH PERSON ENGAGING IN THE PRACTICE IS SUBMITTED TO THE BOARD ,2 IN A FORMAT APPROVED BY THE BOARD , AT LEAST TEN DAYS BEFORE THE3 PERSON PERFORMS THE PRACTICE , AND THE DENTAL THERAPISTS TREAT4 PATIENTS ONLY UNDER DIRECT SUPERVISION OF A LICENSED DENTIST IN5 COMPLIANCE WITH SECTION 12-220-508; OR6 (l) T HE PRACTICE OF DENTAL HYGIENE BY DENTAL HYGIENISTS7 LICENSED IN GOOD STANDING BY OTHER STATES WHILE PROVIDING CARE8 AS A VOLUNTEER, AT THE INVITATION OF ANY GROUP OF LICENSED9 DENTISTS, DENTAL THERAPISTS, OR DENTAL HYGIENISTS IN THIS STATE10 WHO ARE IN GOOD STANDING , SO LONG AS THE PRACTICE IS LIMITED TO11 FIVE CONSECUTIVE DAYS IN A TWELVE-MONTH PERIOD AND THE NAME OF12 EACH PERSON ENGAGING IN THE PRACTICE IS SUBMITTED TO THE BOARD ,13 IN A FORMAT APPROVED BY THE BOARD , AT LEAST TEN DAYS BEFORE THE14 PERSON PERFORMS THE PRACTICE , AND THE DENTAL HYGIENISTS TREAT15 PATIENTS ONLY UNDER DIRECT SUPERVISION OF A LICENSED DENTIST .16 SECTION 8. In Colorado Revised Statutes, 12-220-303, amend17 (2)(a) and (3)(d) as follows:18 12-220-303. Ownership of dental or dental hygiene practice -19 information to be posted - heir to serve as temporary proprietor -20 limitations - definitions. (2) (a) The name, license number, ownership21 percentage, and other information, as required by the board, of each22 proprietor of a dental or dental hygiene practice, including an unlicensed23 heir who is the temporary proprietor of the practice, as specified in24 subsection (3) of this section, must be IMMEDIATELY AND PUBLICLY25 available at the reception desk of the dental or dental hygiene practice26 during the practice's hours of operation. The information required by this27 194 -11- subsection (2)(a) must be available in a format approved by the board.1 (3) (d) The temporary proprietorship of a dental or dental hygiene2 practice by an unlicensed heir does MUST not affect the exercise of the3 independent professional judgment of the licensed dentist or dental4 hygienist providing care to patients on behalf of the practice.5 SECTION 9. In Colorado Revised Statutes, 12-220-304, amend6 (3) as follows:7 12-220-304. Names and status under which dental practice8 may be conducted. (3) The practice of dentistry, dental therapy, or9 dental hygiene by a PROFESSIONAL SERVICE CORPORATION , limited10 liability company of licensees, or by a limited liability partnership of11 licensees is permitted subject to the limitations and requirements, insofar12 as are applicable, set forth in section 12-240-138 relating to a13 PROFESSIONAL SERVICE CORPORATION , limited liability company, or14 limited liability partnership for the practice of medicine.15 SECTION 10. In Colorado Revised Statutes, 12-220-305, amend16 (1)(a), (1)(b), (1)(c), (1)(d), (1)(j), (1)(k), (1)(l), (1)(m), (1)(n), (1)(p),17 (1)(q), (1)(r), and (2); and add (1)(s), (1)(t), (1)(u), and (3) as follows:18 12-220-305. What constitutes practicing dentistry - rules.19 (1) A person is practicing dentistry if the person:20 (a) Performs or attempts or professes to perform any dental21 operation, oral surgery, or dental diagnostic or therapeutic services of any22 kind; except that nothing in this subsection (1)(a) prohibits a dental23 therapist, dental hygienist, or dental assistant from providing preventive24 dental or nutritional counseling, education, or instruction services;25 (b) Is a proprietor of a place where dental operation, oral surgery,26 or dental diagnostic or therapeutic services are performed; except that27 194 -12- nothing in this subsection (1)(b) prohibits a dental therapist, dental1 hygienist, or dental assistant from performing those tasks and procedures2 consistent with section 12-220-501;3 (c) Directly or indirectly, by any means or method, takes A4 PHYSICAL OR DIGITAL impression OR SCAN of the human tooth, teeth,5 jaws, maxillofacial area, or adjacent and associated structures; performs6 any phase of any operation incident to the replacement of a part of a7 tooth; or supplies artificial substitutes for the natural teeth, jaws, or8 adjacent and associated structures; except that nothing in this subsection 9 (1)(c) prohibits a dental therapist, dental hygienist, or dental assistant10 from performing tasks and procedures consistent with sections11 12-220-501 (3)(b)(III), 12-220-503 (1)(d), and 12-220-508;12 (d) Furnishes, supplies, constructs, reproduces, or repairs any A13 prosthetic denture, bridge, appliance, or other structure to be worn in the14 human mouth or upon the jaws, maxillofacial area, or adjacent and15 associated structures other than on the written DENTAL laboratory work16 order of a duly licensed and practicing dentist;17 (j) Extracts or attempts to extract human teeth or corrects, or18 attempts to correct, malformations of human teeth or jaws; except that19 this subsection (1)(j) does not prohibit a dental therapist from performing20 tasks and procedures consistent with section 12-220-508;21 (k) Repairs or fills cavities in human teeth; except that this22 subsection (1)(k) does not prohibit a dental therapist from performing23 tasks and procedures consistent with section 12-220-508;24 (l) Prescribes ionizing radiation or the use of an X ray for the25 purpose of taking dental X rays; or roentgenograms; except that nothing26 in this subsection (1)(l) prohibits these procedures from being delegated27 194 -13- to appropriately trained personnel in accordance with this article 220 and1 rules of the board;2 (m) Gives or professes to give interpretations or readings of dental3 X rays, or roentgenograms, CT scans, or other diagnostic methodologies;4 except that nothing in this subsection (1)(m) prohibits a dental hygienist5 from performing tasks and procedures consistent with sections6 12-220-503 and 12-220-504 or a dental therapist from performing tasks7 consistent with section 12-220-508;8 (n) Represents himself or herself THEMSELF to an individual or the9 general public as practicing dentistry by using the words "dentist" or10 "dental surgeon" or by using the letters "D.D.S.", "D.M.D.",11 "D.D.S./M.D.", or "D.M.D./M.D."; Nothing in this subsection (1)(n)12 prohibits a dental therapist, dental hygienist, or dental assistant from13 performing tasks and procedures consistent with section 12-220-501 (2),14 (2.5), or (3)(b).15 (p) Prescribes drugs or medications and administers local16 anesthesia, analgesia including nitrous oxide/oxygen inhalation,17 medication prescribed or administered for the relief of anxiety or18 apprehension, minimal sedation, moderate sedation, deep sedation, or19 general anesthesia as necessary for the proper practice of dentistry; except20 that nothing in this subsection (1)(p) prohibits:21 (I) A dental hygienist from performing those tasks and procedures22 consistent with sections 12-220-501, 12-220-503 (1)(e) and (1)(g), and23 12-220-504 (1)(c), and in accordance with rules promulgated by the24 board; or25 (II) A dental therapist from performing those tasks and procedures26 consistent with sections 12-220-501 (2.5) and 12-220-508 and in27 194 -14- accordance with rules promulgated by the board.1 (q) Prescribes, induces, and sets dosage levels for inhalation2 anesthesia; except that nothing in this subsection (1)(q) prohibits the3 delegation of monitoring and administration to DENTAL HYGIENISTS AND4 appropriately trained UNLICENSED personnel in accordance with this5 article 220 and rules of the board, INCLUDING REQUIRING TRAINING;6 (r) Gives or professes to give interpretations or readings of dental7 charts or records or gives treatment plans or interpretations of treatment8 plans derived from examinations, patient records, OR dental X rays; or 9 roentgenograms; except that nothing in this subsection (1)(r) prohibits a10 dental therapist, dental hygienist, or dental assistant from performing11 tasks and procedures consistent with sections 12-220-501 (2), (2.5) and12 (3), 12-220-503, 12-220-504, and 12-220-508;13 (s) M AINTAINS PATIENT CLINICAL RECORDS , DENTAL CHARTS,14 IMAGES, TREATMENT PLANS , INTERPRETATIONS , OR OTHER15 DOCUMENTATION, EXCEPT WHEN UNDERGOING A TRANSITION IN PRACTICE16 OWNERSHIP AS PERMITTED IN SECTION 12-220-303 (2);17 (t) (I) P URSUANT TO RULES ADOPTED BY THE BOARD , ORDERS AND 18 ADMINISTERS IMMUNIZATIONS TO PATIENTS SIX YEARS OF AGE OR OLDER .19 T HE BOARD SHALL ADOPT RULES REGARDING DELEGATION OF 20 IMMUNIZATION ADMINISTRATION BY A LICENSED DENTIST TO A DENTAL21 THERAPIST OR DENTAL HYGIENIST AND MAY ADOPT RULES SPECIFYING THE22 MINIMUM TRAINING REQUIREMENTS FOR DENTISTS TO ADMINISTER23 IMMUNIZATIONS.24 (II) A DENTIST WHO ADMINISTERS IMMUNIZATIONS SHALL : 25 (A) N OT PROVIDE MEDICAL OR NONMEDICAL EXEMPTIONS FOR ANY 26 REQUIRED IMMUNIZATIONS;27 194 -15- (B) ENTER ALL IMMUNIZATION -RELATED ADMINISTRATION1 INFORMATION INTO THE COLORADO IMMUNIZATION INFORMATION SYSTEM2 CREATED PURSUANT TO PART 24 OF ARTICLE 4 OF TITLE 25;3 (C) D ISCLOSE THEIR MEDICAL TRAINING RELATED TO PEDIATRIC 4 ADMINISTRATION, INCLUDING THE ABILITY TO MANAGE SIDE EFFECTS OR5 ADVERSE OUTCOMES, TO PATIENTS AS PART OF THE PATIENT CONSENT6 PROCESS;7 (D) A DMINISTER ONLY RESPIRATORY AND ORAL HEALTH , 8 INCLUDING HUMAN PAPILLOMAVIRUS , IMMUNIZATIONS; AND9 (E) D ISTRIBUTE IMMUNIZATION EDUCATIONAL MATERIALS AND 10 RECOMMENDATIONS DEVELOPED BY THE DEPARTMENT OF PUBLIC HEALTH11 AND ENVIRONMENT TO THEIR PATIENTS .12 (u) O RDERS AND ADMINISTERS NEUROMODULATORS AND DERMAL13 FILLERS TO DENTAL PATIENTS OF RECORD FOR THERAPEUTIC AND14 COSMETIC PURPOSES PURSUANT TO RULES ADOPTED BY THE BOARD15 REGARDING REQUIRED TRAINING , ONGOING COMPETENCY , RECORD16 KEEPING, AND DELEGATION TO DENTAL HYGIENISTS .17 (2) A licensed dentist may prescribe orders electronically. THIS18 SECTION DOES NOT PROHIBIT:19 (a) A DENTAL ASSISTANT FROM PERFORMING TASKS AND20 PROCEDURES CONSISTENT WITH SECTION 12-220-501 AND IN ACCORDANCE21 WITH RULES ADOPTED BY THE BOARD ;22 (b) A DENTAL HYGIENIST FROM PERFORMING TASKS AND23 PROCEDURES CONSISTENT WITH SECTIONS 12-220-501, 12-220-503, AND24 12-220-504 AND IN ACCORDANCE WITH RULES ADOPTED BY THE BOARD ;25 OR26 (c) A DENTAL THERAPIST FROM PERFORMING TASKS AND27 194 -16- PROCEDURES CONSISTENT WITH SECTIONS 12-220-501 AND 12-220-5081 AND IN ACCORDANCE WITH RULES ADOPTED BY THE BOARD .2 (3) A PROVIDER PERFORMING ITINERANT SURGERY SHALL DEVELOP3 AND MAINTAIN A WRITTEN PROTOCOL FOR EMERGENCY FOLLOW -UP CARE4 WITH APPROPRIATELY TRAINED PRACTITIONERS FOR ALL PATIENTS5 TREATED. THE PLAN SHALL BE PROVIDED TO EACH PATIENT UNDERGOING6 TREATMENT AND MUST BE AVAILABLE IMMEDIATELY AT THE REQUEST OF7 THE BOARD. THE WRITTEN PROTOCOL MUST INCLUDE A PROVISION THAT8 REQUIRES THE PROVIDER TO INCLUDE IN A PLAN OF CARE FOLLOW -UP9 TREATMENT IN A PERMANENTLY ESTABLISHED TREATMENT FACILITY10 WITHIN A REASONABLE PROXIMITY OF THE LOCATION WHERE ITINERANT11 SURGICAL TREATMENT WAS PERFORMED . THIS FOLLOW-UP TREATMENT12 SHALL BE PROVIDED BY THE ITINERANT SURGICAL TREATMENT OPERATOR13 OR AN APPROPRIATELY TRAINED PRACTITIONER WHO HAS AGREED IN14 WRITING TO PARTICIPATE IN THE EMERGENCY FOLLOW -UP CARE PLAN FOR15 THE ITINERANT SURGICAL TREATMENT OPERATOR . THE APPROPRIATELY16 TRAINED PRACTITIONER MUST BE AVAILABLE WHEN THE ITINERANT17 SURGICAL OPERATOR IS NOT AVAILABLE .18 SECTION 11. In Colorado Revised Statutes, 12-220-306, amend19 (1)(a)(III) and (1)(b); and add (3) and (4) as follows:20 12-220-306. Dentists may prescribe drugs - surgical operations21 - anesthesia - limits on prescriptions - rules. (1) (a) A licensed dentist22 is authorized to:23 (III) Administer, pursuant to A PERMIT REQUIRED BY SECTION24 12-220-411 AND PURSUANT TO board rules, local anesthesia, analgesia25 including nitrous oxide/oxygen inhalation, medication prescribed or26 administered for the relief of anxiety or apprehension, minimal sedation,27 194 -17- moderate sedation, deep sedation, or general anesthesia; and1 (b) A dentist shall not prescribe, distribute, or give to any person,2 including the dentist THEMSELF, any habit-forming drug or any controlled3 substance, as defined in section 18-18-102 (5) or as contained in schedule4 II of 21 U.S.C. sec. 812, other than in the course of legitimate dental5 practice and pursuant to the rules promulgated ADOPTED by the board6 regarding controlled substance record keeping AND IN COMPLIANCE WITH7 THE ELECTRONIC PRESCRIBING OF CONTROLLED SUBSTANCES AS REQUIRED8 BY SECTION 12-30-111.9 (3) A LICENSED DENTIST MAY PRESCRIBE ORDERS10 ELECTRONICALLY.11 (4) A LICENSED DENTIST IS STRONGLY ENCOURAGED TO PURCHASE 12 OR UTILIZE AN ELECTRONIC HEALTH PRODUCT THAT INCLUDES13 INTEGRATION OF A TOOL THAT FACILITATES DENTISTS ' COMPLIANCE WITH14 PRESCRIPTION DRUG MONITORING STANDARDS REQUIRED BY SECTION15 12-30-114 (1)(a)(IV).16 SECTION 12. In Colorado Revised Statutes, 12-220-310, amend17 (1)(a), (1)(b) introductory portion, (1)(b)(IV), (2)(b), and (5); and add18 (2)(d) as follows:19 12-220-310. Dentist peer health assistance program - fees -20 rules. (1) (a) Effective July 1, 2004, as a condition of renewal in this21 state, every AN APPLICANT FOR A DENTIST LICENSE OR A dentist applying22 to renew OR REINSTATE the dentist's license must, AT THE TIME OF23 APPLICATION, pay to the administering entity that has been selected by the24 board pursuant to subsection (1)(b) of this section an amount A FEE not to25 exceed fifty-nine dollars per year, which maximum amount may be26 adjusted on January 1, 2005, and annually thereafter by the board to27 194 -18- reflect changes in the United States department of labor, LABOR'S bureau1 of labor statistics consumer price index, OR A SUCCESSOR INDEX, for2 Denver-Aurora-Lakewood for all urban consumers or goods. or its 3 successor index. The fee shall be used to support designated providers4 that have been selected by the board to provide assistance to dentists5 needing help in dealing with physical, emotional, or psychological6 problems that may be detrimental to their ability to practice dentistry. The7 fee shall MUST not exceed one hundred dollars per year per licensee.8 (b) The board shall select one or more peer health assistance9 programs as designated providers. T HE BOARD OR THE DEPARTMENT MUST 10 PROVIDE PUBLIC NOTICE WHEN A PEER HEALTH ASSISTANCE PROGRAM IS11 BEING CONSIDERED FOR SELECTION AS A DESIGNATED PROVIDER AND12 SHALL PROVIDE A PROCESS FOR STAKEHOLDERS AND THE PUBLIC TO13 PROVIDE INPUT TO THE BOARD REGARDING THE SELECTION OF A14 DESIGNATED PROVIDER. To be eligible for designation by the board, a peer15 health assistance program must:16 (IV) Monitor the status of a dentist who has been referred for17 treatment, INCLUDING PROVIDING TRAINING TO DENTISTS PROVIDING18 PRACTICE MONITORING SERVICES;19 (2) (b) Notwithstanding sections 12-220-201 and 24-4-104, the20 board may immediately suspend the license of any A dentist who is21 referred to a peer health assistance program by the board and who fails to22 attend or complete the program. If the dentist objects to the suspension,23 the dentist may submit a written request to the board, IN A FORMAT24 APPROVED BY THE BOARD, for a formal hearing on the suspension within25 ten days after receiving notice of the suspension, and the board shall grant26 the request. In the hearing, the dentist bears the burden of proving that the27 194 -19- dentist's license should not be suspended.1 (d) A DENTIST MAY SELF-REFER TO PARTICIPATE IN THE PEER2 HEALTH ASSISTANCE PROGRAM OR MAY BE REFERRED BY THE BOARD . A3 DENTIST WHO SELF-REFERS TO THE PEER HEALTH ASSISTANCE PROGRAM4 MAY DO SO CONFIDENTIALLY AND WITHOUT DIRECT NOTIFICATION TO THE5 BOARD. SUCH SELF-REFERRAL TO THE PEER HEALTH ASSISTANCE PROGRAM6 SATISFIES BOARD NOTIFICATION REQUIREMENTS SET FORTH IN SECTION7 12-220-207 AND SUBSECTION (3) OF THIS SECTION; EXCEPT THAT THE PEER8 HEALTH ASSISTANCE PROGRAM SHALL REPORT KNOWLEDGE OF A9 DENTIST'S VIOLATION OF THIS ARTICLE 220 OR RULES OF THE BOARD,10 EXCLUDING KNOWLEDGE OF VIOLATIONS OF SECTION 12-220-201 (1)(e) OR11 (1)(f).12 13 (5) The board is authorized to promulgate MAY ADOPT rules14 necessary to implement this section.15 SECTION 13. In Colorado Revised Statutes, 12-220-402, amend16 (1)(a) as follows:17 12-220-402. Dentist academic license. (1) (a) A dentist who is18 employed at an accredited school or college of dentistry in this state and19 who practices dentistry in the course of the dentist's employment20 responsibilities must either make written FILE AN application to the board21 for an academic license in accordance with this section, IN A FORMAT22 APPROVED BY THE BOARD , or otherwise become licensed pursuant to23 sections 12-220-401 and 12-220-403, as applicable.24 25 SECTION 14. In Colorado Revised Statutes, 12-220-405, amend26 (1)(a) introductory portion as follows:27 194 -20- 12-220-405. Application for dental hygienist license - fee.1 (1) Every person who desires to qualify for practice as a dental hygienist2 within this state must file with the board:3 (a) A written AN application for a license, IN A FORMAT APPROVED4 BY THE BOARD, on which application the applicant shall list:5 6 SECTION 15. In Colorado Revised Statutes, 12-220-407.2,7 amend (1)(a) introductory portion and (1)(b) as follows:8 12-220-407.2. Application for dental therapist license - fee -9 rules. (1) Effective May 1, 2023, every person who desires to qualify for10 practice as a dental therapist within this state must file with the board:11 (a) A written AN application for a license, IN A FORMAT APPROVED12 BY THE BOARD, on which application the applicant must list:13 (b) Satisfactory proof that the applicant:14 (I) Graduated from a school of dental therapy that, at the time of15 the applicant's graduation, was accredited; by the American Dental16 Association's commission on dental accreditation or its successor17 organization; or18 (II) Graduated from a dental therapy education program developed19 prior to February 6, 2015, that, at the time of the applicant's graduation,20 was accredited RECOGNIZED by the Minnesota board of dentistry or21 certified by the Alaska community health aide program certification22 board.23 24 SECTION 16. In Colorado Revised Statutes, 12-220-409, add (6)25 as follows:26 12-220-409. Inactive dental, dental therapist, or dental27 194 -21- hygienist license - rules. (6) T HE BOARD SHALL ADOPT RULES THAT1 ALLOW EXPEDITED, TEMPORARY LICENSURE DURING A DISASTER2 EMERGENCY DECLARED PURSUANT TO SECTION 24-33.5-704 (4) FOR A3 DENTIST, DENTAL HYGIENIST , OR DENTAL THERAPIST WHO HAS4 MAINTAINED A LICENSE IN GOOD STANDING WITH NO PAST DISCIPLINARY5 HISTORY PRIOR TO OBTAINING AN INACTIVE LICENSE . THE RULES MUST6 ADDRESS:7 (a) S UPERVISION OR PRACTICE MONITORING REQUIREMENTS ;8 (b) L IABILITY COVERAGE REQUIREMENTS ;9 (c) O THER CONDITIONS OF OR LIMITATION ON PRACTICE ; AND10 (d) T EMPORARY LICENSE TERMS , ADMINISTRATIVE APPROVALS ,11 TIMELINES, AND RENEWAL OPTIONS.12 SECTION 17. In Colorado Revised Statutes, 12-220-410, add (7)13 as follows:14 12-220-410. Retired dental, dental therapist, and dental15 hygienist licenses - rules. (7) T HE BOARD SHALL ADOPT RULES THAT16 ALLOW EXPEDITED, TEMPORARY LICENSURE DURING A DISASTER 17 EMERGENCY DECLARED PURSUANT TO SECTION 24-33.5-704 (4) FOR A18 DENTIST, DENTAL HYGIENIST , OR DENTAL THERAPIST WHO HAS19 MAINTAINED A LICENSE IN GOOD STANDING WITH NO PAST DISCIPLINARY20 HISTORY PRIOR TO OBTAINING AN INACTIVE LICENSE . THE RULES MUST21 ADDRESS:22 (a) S UPERVISION OR PRACTICE MONITORING REQUIREMENTS ;23 (b) L IABILITY COVERAGE REQUIREMENTS ;24 (c) O THER CONDITIONS OF OR LIMITATION ON PRACTICE ; AND25 (d) T EMPORARY LICENSE TERMS , ADMINISTRATIVE APPROVALS ,26 TIMELINES, AND RENEWAL OPTIONS.27 194 -22- SECTION 18. In Colorado Revised Statutes, 12-220-411, amend1 (1) and (5)(a) as follows:2 12-220-411. Anesthesia and sedation permits - dentists, dental3 therapists, and dental hygienists - training and experience4 requirements - office inspections - rules. (1) (a) 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 (b) T HE BOARD SHALL DESIGN AND IMPLEMENT AN EXPEDITED 10 APPLICATION AND PERMITTING PROCESS FOR A DENTIST WHO HAS11 COMPLETED AN A CCREDITED RESIDENCY PR OGRAM IN GENERAL12 ANESTHESIA OR A POSTDOCTORAL TRAINING PROGRAM THAT PROVIDES13 COMPREHENSIVE AND APPROPRIATE TRAINING NECESSARY TO ADMINISTER14 AND MANAGE MODERATE SEDATION OR DEEP SEDATION AND GENERAL15 ANESTHESIA ACCORDING TO INDUSTRY -ACCEPTED STANDARDS.16 (5) The board shall establish, by rule, criteria and procedures for17 an office inspection program to be completed upon application and18 renewal of anesthesia or sedation permits, which must include:19 (a) Designation of qualified ANESTHESIA inspectors who are 20 experts in dental outpatient deep sedation/general anesthesia and21 moderate sedation; HAVE MORE THAN FIVE YEARS OF EXPERIENCE22 PROVIDING ANESTHESIA SERVICES AND HOLD AN ACTIVE ANESTHESIA23 PERMIT TO PROVIDE EITHER DENTAL OUTPATIENT DEEP24 SEDATION/GENERAL ANESTHESIA OR MODERATE SEDATION . AN25 ANESTHESIA INSPECTOR WHO HOLDS AN ACTIVE ANESTHESIA PERMIT TO26 PROVIDE MODERATE SEDATION MAY ONLY PROVIDE OFFICE ANESTHESIA27 194 -23- INSPECTIONS FOR PROVIDERS WHO REQUEST MODERATE SEDATION1 PRIVILEGES FOR BOTH INITIAL AND RENEWAL PERMIT APPLICATIONS . AN2 ANESTHESIA INSPECTOR WHO HOLDS AN ACTIVE ANESTHESIA PERMIT TO3 PROVIDE DEEP SEDATION/GENERAL ANESTHESIA MAY PROVIDE OFFICE4 ANESTHESIA INSPECTIONS FOR ANY LEVEL OF SEDATION FOR BOTH INITIAL5 AND RENEWAL PERMIT APPLICATIONS . AN ANESTHESIA INSPECTOR SHALL6 COMPLETE AN ANESTHESIA INSPECTOR CALIBRATION PROGRAM CREATED7 AND UPDATED BY THE BOARD ONCE EVERY FIVE YEARS . THE ANESTHESIA8 INSPECTOR RECERTIFICATION MAY BE COMPLETED IN CONJUNCTION WITH9 AN ANESTHESIA PERMIT RENEWAL .10 SECTION 19. In Colorado Revised Statutes, 12-220-412, amend11 (1) as follows:12 12-220-412. Change of address - duplicate licenses and13 certificates. (1) Every A person licensed under this article 220, upon14 changing the licensee's place of business OR CONTACT INFORMATION, shall15 furnish to the board the licensee's new mailing address AND EMAIL16 ADDRESS within thirty days after the change.17 SECTION 20. In Colorado Revised Statutes, 12-220-501, amend18 (1)(a), (3)(a)(VI), (3)(b) introductory portion, and (3)(b)(III); and repeal19 (2) as follows:20 12-220-501. Tasks authorized to be performed by dental21 therapists, dental hygienists, or dental assistants - rules.22 (1) (a) (I) Except as provided in subsection (1)(a)(II) of this section, The23 responsibility for dental diagnosis, dental treatment planning, or the24 prescription of therapeutic measures in the practice of dentistry remains25 with a licensed dentist and may not be assigned to any A dental therapist,26 or dental hygienist, OR DENTAL ASSISTANT.27 194 -24- (II) A dental hygienist may:1 (A) Perform dental hygiene assessment, dental hygiene diagnosis,2 and dental hygiene treatment planning for dental hygiene services3 pursuant to section 12-220-503 (1)(f);4 (B) Identify dental abnormalities for immediate referral to a5 dentist as described in section 12-220-503 (1)(f); and6 (C) In collaboration with a licensed dentist, prescribe, administer,7 and dispense, as described in section 12-220-503 (1)(g): Fluoride,8 fluoride varnish, silver diamine fluoride, antimicrobial solutions for9 mouth rinsing, other nonsystemic antimicrobial agents, and resorbable10 antimicrobial agents pursuant to rules of the board.11 (D) Repealed.12 (2) Except as provided in subsection (1) of this section, a dental13 hygienist may perform any dental task or procedure assigned to the14 hygienist by a licensed dentist that does not require the professional skill15 of a licensed dentist; except that the dental hygienist may perform the task16 or procedure only under the indirect supervision of a licensed dentist or17 as authorized in sections 12-220-503 and 12-220-504.18 (3) (a) A dental assistant shall not perform the following tasks:19 (VI) Scaling (supra and sub-gingival); as it pertains to the practice20 of dental hygiene;21 (b) A dental assistant may perform the following tasks under the22 indirect supervision of a licensed dentist OR THE DIRECT SUPERVISION OF 23 A LICENSED DENTAL THERAPIST OR A LICENSED DENTAL HYGIENIST :24 (III) Gathering and assembling information, including but not25 limited to fact-finding and patient history, oral inspection, and26 RECORDING OF dental and periodontal charting AS DICTATED BY A27 194 -25- LICENSEE;1 SECTION 21. In Colorado Revised Statutes, amend 12-220-5022 as follows:3 12-220-502. Construction of dental devices by unlicensed4 technician. (1) (a) A licensed dentist who uses the services of an5 unlicensed technician for the purpose of constructing, altering, repairing,6 or duplicating any denture, bridge, splint, or orthodontic or prosthetic7 appliance A LABORATORY-FABRICATED INTRAORAL OR MAXILLOFACIAL8 DENTAL PROSTHESIS, PRODUCT, OR APPLIANCE shall furnish the unlicensed9 technician with a written or electronic DENTAL laboratory work order in10 a form approved by THAT COMPLIES WITH RULES OF the board, which form11 shall be dated and signed by the dentist for each separate and individual12 piece of work. The dentist shall make the DENTAL laboratory work order13 in a reproducible DOCUMENTED form, and the dentist and the unlicensed14 technician shall each retain a copy in a permanent file for two years AS A15 PERMANENT PART OF THE PATIENT RECORD . THE LABORATORY16 TECHNICIAN SHALL RETAIN A COPY OF THE DENTAL LABORATORY WORK17 ORDER IN A FILE FOR A MINIMUM OF TWO YEARS . The permanent files of18 the licensed dentist and the unlicensed technician must be open to19 inspection at any reasonable time by the board or its duly constituted20 agent. The licensed dentist that furnishes the DENTAL laboratory work21 order must have appropriate training, education, and experience related22 to the prescribed treatment and is responsible for directly supervising all23 intraoral treatment rendered to the patient.24 (b) I F A PATIENT'S CARE REQUIRES THAT MULTIPLE25 LABORATORY-FABRICATED INTRAORAL OR MAXILLOFACIAL DENTAL26 PROSTHESES OR APPLIANCES BE FABRICATED AT THE SAME TIME , IT IS27 194 -26- PERMISSIBLE TO INCORPORATE THOSE PRODUCTS OR APPLIANCES INTO A1 SINGLE DENTAL LABORATORY WORK ORDER .2 (b) (c) An unlicensed technician that possesses a valid DENTAL3 laboratory work order may provide extraoral construction, manufacture,4 fabrication, supply, or repair of identified dental and orthodontic devices5 but shall not provide intraoral service in a human mouth except under the6 direct supervision of a licensed dentist in accordance with section7 12-220-501 (3)(d).8 (2) If the dentist fails to keep permanent records of DENTAL9 laboratory work orders as required in subsection (1)(a) of this section, the10 dentist is subject to disciplinary action as deemed appropriate by the11 board.12 (3) If an unlicensed technician fails to have in the technician's13 possession a DENTAL laboratory work order signed by a licensed dentist14 with each denture, bridge, splint, or orthodontic or prosthetic appliance15 in the technician's possession, the absence of the DENTAL laboratory work16 order is prima facie evidence of a violation of this section and constitutes17 the practice of dentistry without an active license in violation of, and18 subject to the penalties specified in, section 12-220-211. 19 SECTION 22. In Colorado Revised Statutes, 12-220-503, amend20 (1) introductory portion, (1)(d)(II), (1)(d)(IV), (1)(d)(V), (1)(f), (1)(g)(I),21 (1)(g)(III)(A), (1)(g)(III)(B), (1)(g)(III)(C), (1)(g)(IV) introductory22 portion, (2), and (4); repeal (1)(g)(II)(A); and add (1)(d)(VI), (1)(e.5),23 (1)(g)(V), and (1)(h) as follows:24 12-220-503. What constitutes practicing unsupervised dental25 hygiene - rules. (1) N OTWITHSTANDING SUBSECTION (3) OF THIS26 SECTION, unless licensed to practice dentistry, a person AN INDIVIDUAL is27 194 -27- deemed to be practicing unsupervised dental hygiene when the person1 INDIVIDUAL, within the scope of the person's INDIVIDUAL'S education,2 training, and experience:3 (d) Gathers and assembles information, including but not limited4 to:5 (II) Preparation PROVISION of study casts for the purpose of6 fabricating a permanent record of the patient's present condition; as a7 visual aid for patient education, dental hygiene diagnosis, and dental8 hygiene treatment planning; and to provide assistance during forensic9 examination OR DIGITAL SCANS;10 (IV) Dental CHARTING and periodontal PROBING AND charting; and 11 (V) Radiographic and X-ray survey for the purpose of assessing12 and diagnosing dental hygiene-related conditions for treatment planning13 for dental hygiene services as described in this section and identifying14 dental HARD AND SOFT TISSUE abnormalities for immediate referral to a15 dentist OR APPROPRIATE SPECIALIST; AND16 (VI) A DDITIONAL SCREENING OR SCREENING TESTS FOR FURTHER17 INVESTIGATION OF ANY ORAL OR SYSTEMIC HEALTH -RELATED CONCERN 18 PERTINENT TO THE SCOPE OF PRACTICE FOR DENTAL HYGIENE ; AND19 (e.5) A DMINISTERS LOCAL ANESTHESIA IN COMPLIANCE WITH20 SECTION 12-220-411 AND RULES ADOPTED BY THE BOARD , INCLUDING21 MINIMUM EDUCATION REQUIREMENTS AND PROCEDURES FOR LOCAL22 ANESTHESIA ADMINISTRATION ;23 (f) Performs dental hygiene assessment, dental hygiene diagnosis,24 and dental hygiene treatment planning FOR HARD AND SOFT TISSUE for25 dental hygiene services as described in this section and identifies dental26 abnormalities for immediate referral to a dentist OR APPROPRIATE27 194 -28- SPECIALIST; or1 (g) (I) Prescribes, administers, and dispenses fluoride, fluoride2 varnish, silver diamine fluoride FLUORIDES in accordance with subsection3 (1)(g)(IV) of this section, antimicrobial solutions for mouth rinsing, other4 nonsystemic antimicrobial agents, and related emergency drugs and5 reversal agents. in collaboration with a licensed dentist. The board, by6 rule, may further define the permissible and appropriate emergency drugs7 and reversal agents. An articulated plan with a collaborating dentist for8 dental hygiene prescribing must describe any protocols, restrictions or9 limitations, follow-up and referral mechanisms, notification and10 disclosure requirements, and any other requirements established by the11 board by rule. Dental hygienists shall maintain clear documentation in the12 patient record of the drug or agent prescribed, administered, or dispensed;13 the date of the action; and the rationale for prescribing, administering, or14 dispensing the drug or agent.15 (II) A dental hygienist shall not prescribe, administer, or dispense16 the following:17 (A) Drugs whose primary effect is systemic, with the exception of18 fluoride supplements permitted under subsection (1)(g)(III)(A) of this19 section; and20 (III) A dental hygienist may prescribe the following:21 (A) Fluoride supplements; as follows, all using sodium fluoride:22 Tablets: 0.5 mg, 1.1 mg, or 2.2 mg; lozenges: 2.21 mg; and drops: 1.123 mL;24 (B) Topical anti-caries treatments, as follows, all using sodium25 fluoride unless otherwise indicated: Toothpastes: 1.1% or less (or26 stannous fluoride 0.4%); topical gels: 1.1% or less (or stannous fluoride27 194 -29- 0.4%); oral rinses: 0.05%, 0.2%, 0.44%, or 0.5%; oral rinse concentrate1 used in periodontal disease: 0.63% stannous fluoride; fluoride varnish:2 5%; silver diamine fluoride: 38%; and prophy pastes containing3 approximately 1.23% sodium fluoride and used for polishing procedures4 as part of professional dental prophylaxis treatment INCLUDING SODIUM5 FLUORIDE, STANNOUS FLUORIDE , SILVER DIAMINE FLUORIDE , OTHER6 SILVER FLUORIDES, HYDROXYAPATITE REGENERATION MEDICAMENTS7 USED FOR REPAIRING CAVITIES, AND ALTERNATIVES FOR STRENGTHENING8 TEETH AND PREVENTING AND ARRESTING TOOTH DECAY . THE BOARD MAY9 ADOPT RULES THAT IDENTIFY SAFE PRESCRIBING ALTERNATIVES TO SILVER10 DIAMINE FLUORIDE AS A TREATMENT FOR STRENGTHENING TEETH AND11 PREVENTING TOOTH DECAY .12 (C) Topical anti-infectives, as follows: Chlorhexidine gluconate13 rinses: 0.12%; chlorhexidine gluconate periodontal chips for subgingival14 insertion into a periodontal pocket/sulcus; tetracycline impregnated fibers,15 inserted subgingivally into a periodontal pocket/sulcus; doxycycline16 hyclate periodontal gel, inserted subgingivally into a periodontal17 pocket/sulcus; and minocycline hydrochloride periodontal powder,18 inserted subgingivally into a periodontal pocket/sulcus INCLUDING19 CHLORHEXIDINE GLUCONATE RINSE , PERIODONTAL CHIPS, PERIODONTAL20 GELS, PERIODONTAL POWDERS , AND IMPREGNATED FIBERS FOR21 PERIODONTAL TREATMENT ; and22 (IV) A dental hygienist may prescribe and apply silver diamine23 fluoride AND OTHER SILVER FLUORIDES upon completion of a24 postsecondary course or continuing education course developed at the25 postsecondary level that satisfies the requirements established by the26 board and provides instructions on the use and limitations of applying27 194 -30- silver diamine fluoride. A dental hygienist may complete the course1 described in this subsection (1)(g)(IV) through:2 (V) A DENTAL HYGIENIST MAY PRESCRIBE , DISPENSE, AND 3 ADMINISTER NONNARCOTIC ANALGESICS , ANTI-INFLAMMATORIES, AND4 ANTIBIOTICS WITHIN THE PARAMETERS OF A WRITTEN ARTICULATED PLAN ,5 WITH THE AUTHORIZATION OF THE SUPERVISING DENTIST , AND UPON6 COMPLETION OF A POSTSECONDARY C OURSE OR CONTINUING EDUCATION7 COURSE DEVELOPED AT THE POSTSECONDARY LEVEL THAT SATISFIES THE8 REQUIREMENTS ESTABLISHED BY THE BOARD AND THAT PROVIDES9 INSTRUCTION ON THE USE AND LIMITATIONS OF NONNARCOTIC10 ANALGESICS, ANTI-INFLAMMATORIES, AND ANTIBIOTICS.11 (h) D IRECTS DENTAL ASSISTANTS TO ASSIST IN ACTIVITIES THAT12 ARE WITHIN THE SCOPE OF PRACTICE FOR A DENTAL HYGIENIST UNDER13 DIRECT SUPERVISION OF A DENTAL HYGIENIST ONLY; EXCEPT THAT DENTAL14 ASSISTANTS SHALL NOT PERFORM ACTIVITIES DISALLOWED UNDER SECTION15 12-220-501 (3)(a).16 (2) A dental hygienist shall state in writing and require a patient17 to acknowledge by signature that any diagnosis or assessment is for the18 purpose of determining necessary dental hygiene services only. and that 19 it is recommended by the American Dental Association, or any successor20 organizations, that a thorough dental examination be performed by a21 dentist twice each year.22 (4) (a) Notwithstanding section 12-220-104 (13) or 12-220-30523 (1)(b), AND CONSISTENT WITH SECTION 12-220-303, a dental hygienist24 may be the proprietor of a place where supervised or unsupervised dental25 hygiene is performed and may purchase, own, or lease equipment,26 DENTAL MATERIALS, AND SUPPLIES necessary to perform supervised or27 194 -31- unsupervised dental hygiene.1 (b) A dental hygienist proprietor, or a professional corporation,2 LIMITED LIABILITY PARTNERSHIP , or professional limited liability3 corporation of dental hygienists, in addition to providing dental hygiene4 services, may enter into an agreement with one or more dentists for the5 lease or rental of equipment or office space in the same physical location6 as the dental hygiene practice, but only if the determination of necessary7 dental services provided by the dentist and professional responsibility for8 those services, including but not limited to dental records, appropriate9 medication, and patient payment, remain with the treating dentist. It is the10 responsibility of the dental hygienist to inform the patient as to whether11 there is a supervisory relationship between the dentist and the dental12 hygienist. An agreement under this subsection (4)(b) does not constitute13 employment and does not constitute cause for discipline pursuant to14 section 12-220-201 (1)(h). 15 SECTION 23. In Colorado Revised Statutes, amend 12-220-504,16 as follows:17 12-220-504. What constitutes practicing supervised dental18 hygiene - rules. (1) N OTWITHSTANDING SECTION 12-220-501 (3), unless19 licensed to practice dentistry, a person who performs any of the following20 tasks under the supervision of a licensed dentist is deemed to be21 practicing supervised dental hygiene:22 (a) Performing a task described in section 12-220-503 (1); 23 (b) Preparing study casts;24 (c) Administering local anesthesia under the indirect supervision25 of a licensed dentist pursuant to rules of the board, including minimum26 education requirements and procedures for local anesthesia27 194 -32- administration; or1 (d) Placing interim therapeutic restorations pursuant to section2 12-220-505.3 (e) Repealed.4 (b) ADMINISTERING AND MONITORING INHALATION ANESTHESIA5 UNDER THE INDIRECT SUPERVISION OF A DENTIST CONSISTENT WITH6 SECTION 12-220-305 (1)(q) AND PURSUANT TO THE RULES OF THE BOARD7 REGARDING TRAINING AND MINIMUM EDUCATION REQUIREMENTS ;8 (c) UTILIZING A LASER FOR DENTAL HYGIENE PURPOSES WITHIN9 DEFINED SCOPES OF PRACTICE IN ACCORDANCE WITH RULES OF THE BOARD ;10 (d) (I) P URSUANT TO RULES ADOPTED BY THE BOARD , 11 ADMINISTERING IMMUNIZATIONS , UNDER THE DIRECT SUPERVISION OF A12 LICENSED DENTIST OR THE DELEGATION OF A LICENSED PROFESSIONAL13 WHO IS AUTHORIZED TO ADMINISTER IMMUNIZATIONS AND DELEGATE14 TASKS UNDER THIS TITLE 12, TO PATIENTS SIX YEARS OF AGE OR OLDER.15 T HE BOARD MAY ADOPT RULES SPECIFYING THE MINIMUM TRAINING 16 REQUIREMENTS FOR DENTAL HYGIENISTS TO ADMINISTER IMMUNIZATIONS.17 (II) A DENTAL HYGIENIST WHO ADMINISTERS IMMUNIZATIONS18 SHALL:19 (A) N OT PROVIDE MEDICAL OR NONMEDICAL EXEMPTIONS FOR ANY 20 REQUIRED IMMUNIZATIONS;21 (B) E NTER ALL IMMUNIZATION -RELATED ADMINISTRATION 22 INFORMATION INTO THE COLORADO IMMUNIZATION INFORMATION SYSTEM23 CREATED PURSUANT TO PART 24 OF ARTICLE 4 OF TITLE 25;24 (C) D ISCLOSE THEIR MEDICAL TRAINING RELATED TO PEDIATRIC 25 ADMINISTRATION, INCLUDING THE ABILITY TO MANAGE SIDE EFFECTS OR26 ADVERSE OUTCOMES, TO PATIENTS AS PART OF THE PATIENT CONSENT27 194 -33- PROCESS;1 (D) A DMINISTER ONLY RESPIRATORY AND ORAL HEALTH , 2 INCLUDING HUMAN PAPILLOMAVIRUS , IMMUNIZATIONS; AND3 (E) D ISTRIBUTE IMMUNIZATION EDUCATIONAL MATERIALS AND 4 RECOMMENDATIONS DEVELOPED BY THE DEPARTMENT OF PUBLIC HEALTH5 AND ENVIRONMENT TO THEIR PATIENTS .6 (e) ADMINISTERING NEUROMODULATORS AND DERMAL FILLERS7 FOR THERAPEUTIC AND COSMETIC PURPOSES UNDER THE DIRECT8 SUPERVISION OF A LICENSED DENTIST, OR THE DELEGATION OF A LICENSED9 PHYSICIAN OR OTHER DELEGATED PROFESSIONAL , PURSUANT TO RULES10 ADOPTED BY THE BOARD . THE BOARD SHALL ADOPT RULES REGARDING11 THE APPROPRIATE EDUCATION AND TRAINING , AS APPLICABLE.12 13 (f) P LACING INTERIM THERAPEUTIC RESTORATIONS PURSUANT TO 14 SECTION 12-220-505.15 (2) A DENTAL HYGIENIST MAY PERFORM ANY DENTAL TASK OR16 PROCEDURE ASSIGNED TO THE DENTAL HYGIENIST BY A LICENSED DENTIST17 THAT DOES NOT REQUIRE THE PROFESSIONAL SKILL OF A LICENSED18 DENTIST; EXCEPT THAT THE DENTAL HYGIENIST MAY PERFORM THE TASK19 OR PROCEDURE ONLY UNDER THE INDIRECT SUPERVISION OF A LICENSED20 DENTIST OR AS AUTHORIZED IN SECTIONS 12-220-503 AND 12-220-504.21 SECTION 24. In Colorado Revised Statutes, 12-220-505, amend22 (1)(b), (1)(d), and (6)(a); and add (6)(c) as follows:23 12-220-505. Interim therapeutic restorations by dental24 hygienists - permitting process - rules - subject to review. (1) Upon25 application, accompanied by a fee in an amount determined by the26 director, the board shall grant a permit to place interim therapeutic27 194 -34- restorations to any dental hygienist applicant who:1 (b) Has completed a course developed at the postsecondary2 educational level that complies with the rules adopted by the board. The3 course must be offered under the direct supervision of a member of the4 faculty of a AN ACCREDITED Colorado dental or dental hygiene school.5 accredited by the Commission on Dental Accreditation or its successor6 agency. All faculty responsible for clinical evaluation of students must be7 dentists with a faculty appointment at an accredited Colorado dental or8 dental hygiene school.9 (d) Furnishes, supplies, constructs, reproduces, or repairs any10 prosthetic denture, bridge, appliance, or other structure to be worn in the11 human mouth or upon the jaws, maxillofacial area, or adjacent and12 associated structures other than on the written DENTAL laboratory work13 order of a duly licensed and practicing dentist;14 (6) (a) A dentist shall not supervise more than five full-time15 equivalent dental hygienists who place interim therapeutic restorations16 under telehealth supervision unless granted a waiver by the board17 pursuant to subsection (6)(b) of this section. For purposes of patient 18 referral for follow-up care, A dentist who supervises a dental hygienist19 who provides interim therapeutic restorations under telehealth supervision20 must have an active license in good standing issued by the board. and a21 physical practice location in Colorado or within reasonable proximity of22 the location where the interim therapeutic restoration is placed BEFORE23 PROVIDING INTERIM THERAPEUTIC RESTORATIONS , A DENTAL HYGIENIST24 SHALL CONFIRM IN COMMUNICATION TO THE SUPERVISING DENTIST A25 REFERRAL FOR FOLLOW -UP CARE TO A LICENSED DENTIST WITHIN26 REASONABLE PHYSICAL PROXIMITY TO THE LOCATION WHERE THE INTERIM27 194 -35- THERAPEUTIC RESTORATION IS PLACED .1 (c) A DENTIST SHALL NOT SUPERVISE, IN AGGREGATE, MORE THAN2 FIVE FULL-TIME EQUIVALENT DENTAL HYGIENISTS OR DENTAL THERAPISTS3 PERFORMING PROCEDURES PURSUANT TO SUBSECTION (6)(a) OF THIS4 SECTION AND SECTION 12-220-508, AND LIMITS ON SUPERVISION OF5 DENTAL THERAPISTS MUST REMAIN CONSISTENT WITH SECTION 12-220-5086 (3).7 SECTION 25. In Colorado Revised Statutes, 12-220-508, amend8 (1)(a) introductory portion, (1)(a)(VIII), (2)(a)(VI), and (3)(a); and add9 (1)(c)(IX) and (3)(d) as follows:10 12-220-508. Practice of dental therapy - supervision11 requirement - rules. (1) (a) A dental therapist may perform the12 following tasks and procedures under the direct supervision of a licensed13 dentist WITH AN ACTIVE LICENSE IN GOOD STANDING :14 (VIII) Repair defective prosthetic devices.15 (c) A dental therapist licensed pursuant to this article 220 may16 perform the following tasks under the indirect supervision of a licensed17 dentist, regardless of the number of hours the dental therapist has18 practiced:19 (IX) D IRECTING DENTAL ASSISTANTS TO ASSIST IN ACTIVITIES20 THAT ARE WITHIN THE SCOPE OF PRACTICE FOR A DENTAL THERAPIST21 UNDER DIRECT AND INDIRECT SUPERVISION OF THE DENTAL THERAPIST22 ONLY; EXCEPT THAT DENTAL ASSISTANTS SHALL NOT PERFORM ACTIVITIES23 DISALLOWED UNDER SECTION 12-220-501 (3)(a).24 (2) (a) An articulated plan between a dental therapist and a dentist25 must include:26 (VI) C ONSISTENT WITH DENTAL ASSISTANTS ' SCOPE OF PRACTICE,27 194 -36- policies for supervising dental assistants and working with dental1 hygienists and other dental practitioners and staff.2 (3) (a) Except as provided in subsection (3)(b), or (3)(c), OR (3)(d)3 of this section, a dentist may not simultaneously supervise more than4 three full-time or full-time-equivalent dental therapists.5 (d) A DENTIST SHALL NOT SUPERVISE IN AGGREGATE MORE THAN6 FIVE FULL-TIME EQUIVALENT DENTAL HYGIENISTS OR DENTAL THERAPISTS7 PURSUANT TO THIS SECTION AND SECTION 12-220-505 (6)(a), AND LIMITS8 ON SUPERVISION OF DENTAL THERAPISTS MUST REMAIN CONSISTENT WITH9 THIS SUBSECTION (3).10 SECTION 26. In Colorado Revised Statutes, 24-34-104, repeal11 (26)(a)(I); and add (35)(a)(VI) as follows:12 24-34-104. General assembly review of regulatory agencies13 and functions for repeal, continuation, or reestablishment - legislative14 declaration - repeal. (26) (a) The following agencies, functions, or both,15 are scheduled for repeal on September 1, 2025:16 (I) The Colorado dental board created in article 220 of title 12;17 (35) (a) The following agencies, functions, or both, are scheduled18 for repeal on September 1, 2034:19 (VI) T HE COLORADO DENTAL BOARD CREATED IN ARTICLE 220 OF20 TITLE 12.21 SECTION 27. Repeal of relocated provisions. In Colorado22 Revised Statutes, repeal 12-220-104 (11).23 SECTION 28. Act subject to petition - effective date. This act24 takes effect at 12:01 a.m. on the day following the expiration of the25 ninety-day period after final adjournment of the general assembly; except26 that, if a referendum petition is filed pursuant to section 1 (3) of article V27 194 -37- of the state constitution against this act or an item, section, or part of this1 act within such period, then the act, item, section, or part will not take2 effect unless approved by the people at the general election to be held in3 November 2026 and, in such case, will take effect on the date of the4 official declaration of the vote thereon by the governor.5 194 -38-