This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0855c.HHS
DATE: 2/9/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 855 Dental Services
SPONSOR(S): Health & Human Services Committee, McClure and others
TIED BILLS: IDEN./SIM. BILLS: SB 302
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 16 Y, 0 N Osborne McElroy
2) Health & Human Services Committee 17 Y, 0 N, As CS Osborne Calamas
SUMMARY ANALYSIS
The Board of Dentistry, within the Department of Health (DOH), regulates dental practice in Florida, including
dentists, dental hygienists, and dental assistants under the Dental Practice Act. A dentist is licensed to
examine, diagnose, treat, and care for conditions within the human oral cavity and its adjacent tissues and
structures. A dental hygienist provides education, preventive and delegated therapeutic dental services. There
are approximately 17,193 dentists, 17,681 dental hygienists, and 8,371 dental radiographers with active
licenses to practice in Florida. There are 41 out-of-state registered telehealth dentists.
Telehealth is the use of synchronous or asynchronous telecommunications technology by a health care
practitioner to provide health care services. Current law sets the standard of care for telehealth providers at the
same standard of care for health care practitioners providing in-person health care services to patients in this
state. This ensures that a patient receives the same standard of care irrespective of the modality used by the
health care practitioner to deliver the services. Current law does not contain health care practitioner-specific
regulations for the use of telehealth. Health care practitioners must adhere to the applicable standard of care
when providing services through telehealth and are subject to disciplinary action if they fail to do so.
CS/HB 855 revises existing standards for the practice of dentistry and establishes new requirements that
specifically apply to providers using telehealth to provide dental services to patients. The bill requires any
partnership, corporation, or other business entity that advertises dental services to designate a dentist of
record with the Board of Dentistry. The also bill requires advertisements for certain dental services provided
through telehealth to include a disclaimer.
The bill requires every dentist to provide each patient with the dentist’s name, contact telephone number, after-
hours contact information for emergencies, and license information; failure to do so constitutes grounds for
discipline.
The bill requires a dentist to perform an in-person examination on a patient, or review records from an in-
person examination of the patient from the last 12 months, before the dentist makes an initial diagnosis and
correction of a malposition of teeth, or the initial use of an orthodontic appliance. Failure to adhere to this
requirement constitutes grounds for discipline. This requirement would only impact dentists providing services
via telehealth, and would have the effect of eliminating direct-to-consumer alignment business models, unless
such businesses are able to incorporate in-person visits that satisfy this requirement.
The bill has an indeterminate negative fiscal impact on DOH, and no fiscal impact on local government.
The bill provides an effective date of July 1, 2024. STORAGE NAME: h0855c.HHS PAGE: 2
DATE: 2/9/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Regulation of Dental Practice in Florida
The Board of Dentistry (BOD), within the Department of Health (DOH), regulates dental practice in
Florida, including dentists, dental hygienists, and dental assistants under the Dental Practice Act.
1
A
dentist is licensed to examine, diagnose, treat, and care for conditions within the human oral cavity and
its adjacent tissues and structures.
2
A dental hygienist provides education, preventive and delegated
therapeutic dental services.
3
There are currently 17,193 dentists, 17,681 dental hygienists, and 8,371 dental radiographers with
active licenses to practice in Florida. There are 41 out-of-state registered telehealth dentists.
4
Dental Licensure
Any person wishing to practice dentistry in this state must apply to the Department of Health (DOH) and
meet specified requirements. Section 466.006, F.S., requires dentistry licensure applicants to sit for
and pass the following licensure examinations:
The National Board of Dental Examiners dental examiner (NBDE);
A written examination on Florida laws and rules regulating the practice of dentistry; and
A practical examination, which is the American Dental Licensing Examination (ADEX)
developed by the American Board of Dental Examiners, Inc.
5
To qualify to take the Florida dental licensure examination, an applicant must be 18 years of age or
older, be a graduate of a dental school accredited by the American Dental Association or be a student
in the final year of a program at an accredited institution, and have successfully completed the NBDE
dental examination.
Dental Practice
Dentists must maintain professional liability insurance or provide proof of financial responsibility. If the
dentist obtains professional liability insurance, the coverage must be at least $100,000 per claim, with a
minimum annual aggregate of at least $300,000.
6
Alternatively, a dentist may maintain an unexpired,
irrevocable letter of credit in the amount of $100,000 per claim, with a minimum aggregate availability of
credit of at least $300,000.
7
The professional liability insurance must provide coverage for the actions
of any dental hygienist supervised by the dentist.
8
However, a dentist may be exempt from maintaining
professional liability insurance if he or she:
9
Practices exclusively for the federal government or the State of Florida or its agencies or
subdivisions;
1
S. 466.004, F.S.
2
S. 466.003(3), F.S.
3
S. 466.003(4)-(5), F.S.
4
See, Department of Health License Verification web search. Available at https://mqa-
internet.doh.state.fl.us/MQASearchServices/HealthCareProviders (last visited January 14, 2023).
5
A passing score is valid for 365 days after the date the official examination results are published. A passing score on an examination
obtained in another jurisdiction must be completed on or after October 1, 2011.
6
Rule 64B5-17.011(1), F.A.C.
7
Rule 64B5-17.011(2), F.A.C.
8
Rule 64B5-17.011(4), F.A.C.
9
Rule 64B5-17.011(3), F.A.C. STORAGE NAME: h0855c.HHS PAGE: 3
DATE: 2/9/2024
Is not practicing in this state;
Practices only in conjunction with his or her teaching duties at an accredited school of dentistry
or in its main teaching hospitals; or
Demonstrates to the BOD that he or she has no malpractice exposure in this state.
Current law requires that a dentist of record be established in the patient record for each dental patient.
The dentist of record assumes primary responsibility for all dental treatment for the patient, regardless
of whether the treatment is rendered by the dentist of record, or another dentist, dental hygienist, or
dental assistant in conjunction with, at the direction or request of, or under the supervision of the dentist
of record.
10
The dentist of record is the dentist identified and noted in the patient record as the dentist of record, or
who provides a specific treatment or service and is noted in the patient record as the dentist of record
for that treatment or service.
11
For instances where a dentist of record is not identified in the patient’s
record, it is assumed that the dentist of record is the owner of the dental practice in which the patient is
treated.
12
By rule, every dentist is required to provide, either personally, through another licensed dentist, or
through a reciprocal agreement with another agency, reasonable 24-hour emergency services for all
patients under his or her continuing care.
13
Every dentist licensed in Florida must post and keep conspicuously displayed his or her license in the
office wherein she or he practices and in plain sight of patients.
14
Dental Hygienists
A dental hygienist provides education, preventive and delegated therapeutic dental services under
varying levels of supervision by a licensed dentist.
15
Any person wishing to be licensed as a dental
hygienist must apply to DOH and meet the following qualifications:
16
Be 18 years of age or older;
Be a graduate of an accredited dental hygiene college or school;
17
and
Obtain a passing score on the:
o Dental Hygiene National Board Examination;
o Dental Hygiene Licensing Examination developed by the American Board of Dental
Examiners, Inc., which is graded by a Florida-licensed dentist or dental hygienist
employed by DOH for such purpose; and
o A written examination on Florida laws and rules regulating the practice of dental
hygiene.
A dental hygienist is not required to maintain professional liability insurance and must be covered by
supervising dentist’s liability insurance.
18
A supervising dentist may delegate certain tasks to a dental hygienist, such as removing calculus
deposits, accretions, and stains from exposed surfaces of the teeth and from the gingival sulcus and
10
S. 466.018, F.S.
11
Rule 64B5-17.002, F.A.C.
12
S. 466.018(1)-(2), F.S.; see also, rule 64B5-17.002, F.A.C.; see also, 466.0285, F.S., no person other than a licensed dentist, or an
entity composed of dentists, may employ a dentist in the operation of a dental office.
13
Rule 64B5-17.004, F.A.C.
14
S. 466.016, F.S.
15
S. 466.003(4)-(5), F.S.
16
S. 466.007, F.S.
17
If the school is not accredited, the applicant must have completed a minimum of 4 years of postsecondary dental education and
received a dental school diploma which
is comparable to a D.D.S. or D.M.
18
Supra, note 8. STORAGE NAME: h0855c.HHS PAGE: 4
DATE: 2/9/2024
the task of performing root planning and curettage.
19
A dental hygienist may also expose dental X-ray
films, apply topical preventive or prophylactic agents, and delegated remediable tasks.
20
Remediable
tasks are intra-oral tasks which do not create an unalterable change in the oral cavity or contiguous
structures, are reversible, and do not expose a risk to the patient, including but not limited to:
Fabricating temporary crowns or bridges inter-orally;
Selecting and pre-sizing orthodontic bands;
Preparing a tooth service by applying conditioning agents for orthodontic appliances;
Removing and re-cementing properly contoured and fitting loose bands that are not
permanently attached to any appliance;
Applying bleaching solution, activating light source, and monitoring and removing in-office
bleaching solution;
Placing or removing rubber dams;
Making impressions for study casts which are not being made for the purpose of fabricating any
intra-oral appliances, restorations, or orthodontic appliances;
Taking impressions for passive appliances, occlusal guards, space maintainers, and protective
mouth guards; and
Cementing temporary crowns and bridges with temporary cement.
A dental hygienist may perform additional remediable tasks as delegated by the supervising dentist if
they have received additional training in a pre-licensure course, other formal training, or on-the-job
training.
21
To administer local anesthesia, a dental hygienist obtain certification which requires the
dental hygienist completes an accredited course of 30 hours of didactic training and 30 hours of clinical
training and is certified in basic or advanced cardiac life support. Once certified, the dental hygienist
may only administer local anesthesia to a non-sedated, adult patient.
22
Every dental hygienist licensed in Florida must post and keep conspicuously displayed
his or her license in the office wherein she or he practices, in plain sight of patients.
23
Dental Advertising
Florida regulates dental advertising
24
to ensure that the public has access to information which provides
a sufficient basis to make an informed selection of dentists and protect it from false or misleading
advertisements.
25
A licensed dentist’s advertisements may not contain any false, fraudulent, misleading, or deceptive
statement or claim or any statement or claim which:
26
Contains misrepresentations of fact;
Is likely to mislead or deceive because, in context, it makes only a partial disclosure of relevant
facts;
Contains laudatory statements about the dentist or group of dentists;
Is intended or is likely to create false, unjustified expectations of favorable results;
Relates to the quality of dental services provided as compared to other available dental
services;
Is intended or is likely to appeal primarily to a layperson’s fears;
19
S. 466.023, F.S.
20
Ss. 466.023 and 466.024, F.S.
21
See, ss. 466.023, 466.0235, and 466.024, F.S.; and Rule 64B5-16, F.A.C.
22
S. 466.017(5), F.S.
23
S. 466.016, F.S.
24
Rule 64B5-4.002, F.A.C., defines advertising to mean any statements, oral or written, disseminated to or before the public or any
portion thereof with the intent of furthering the purpose, either directly or indirectly, of selling professional services, or offering to perform
professional services, or inducing members of the public to enter into any obligation relating to such professional services. The
provisions of this rule shall apply to media exposure of any nature regardless of whether it is in the form of paid advertising.
25
S. 468.019, F.S.
26
Id. STORAGE NAME: h0855c.HHS PAGE: 5
DATE: 2/9/2024
Contains fee information without a disclaimer that such is a minimum fee only; or
Contains other representations or implications that in reasonable probability will cause an
ordinary, prudent person to misunderstand or to be deceived.
Direct-To-Consumer Teeth Alignment
The direct-to-consumer teeth alignment business model consists of dental impressions being taken by
the consumer using a dental impression kit provided by the aligner company. The impression is then
reviewed by a dentist to create custom aligners, which are shipped back to the consumer for use. This
model generally does not include an in-person examination by a licensed dentist or include direct
supervision by a dentist when digital scanning is performed.
27
Telehealth
Telehealth is the delivery of health care services using information and communication technologies to
exchange valid information for diagnosis, treatment and prevention of disease and injuries, research
and evaluation.
28
Telehealth connects individuals and their health care providers when in-person care
is not possible. Current law broadly defines telehealth as the use of synchronous or asynchronous
telecommunications technology by a telehealth provider to provide health care services, including, but
not limited to:
Assessment, diagnosis, consultation, treatment, and monitoring of a patient;
Transfer of medical data;
Patient and professional health-related education;
Public health services; and
Health administration.
Florida-licensed health care practitioners, registered out-of-state health practitioners, and those
licensed under a multistate health care licensure compact of which Florida is a member, are authorized
to use telehealth to deliver health care services to patients within the state according to the
practitioners’ respective scopes of practice. Providers treating Florida patients via telehealth must
comply with the applicable practitioner scope of practice under Florida law; not the scope of practice of
the state where the practitioner is physically located.
29
Florida-licensed telehealth providers, as well as those licensed under a multistate health care licensure
compact of which Florida is a member, include:
30
Behavioral Analyst
Acupuncturist
Allopathic physician
Osteopathic physician
Chiropractor
Podiatrist
Optometrist
Nurse
Pharmacist
Dentist
Dental hygienist
Midwife
Occupational therapist
Radiology technician
Electrologist
Orthotist
Pedorthist
Prosthetist
Medical physicist
Emergency Medical
Technician
Paramedic
Massage therapist
Optician
Clinical laboratory
personnel
Respiratory therapist
Physical therapist
Psychologist
Psychotherapist
Dietician/Nutritionist
Athletic trainer
Clinical social worker
Marriage and family
therapist
Mental health counselor
27
Department of Health, Agency Bill Analysis for HB 855 (2024). On file with the Health and Human Services Committee.
28
U.S. Department of Health and Human Services, Report to Congress: E-Health and Telemedicine (August 2016). Available at
https://aspe.hhs.gov/system/files/pdf/206751/TelemedicineE-HealthReport.pdf (last visited January 14, 2024).
29
S. 456.47, F.S.
30
These are professionals licensed under s. 393.17; part III, ch. 401; ch. 457; ch. 458; ch. 459; ch. 460; ch. 461; ch. 463; ch. 464; ch.
465; ch. 466; ch. 467; part I, part III, part IV, part V, part X, part XIII, and part XIV, ch. 468; ch. 478; ch. 480; part II and part III, ch. 483;
ch. 484; ch. 486; ch. 490; or ch. 491. STORAGE NAME: h0855c.HHS PAGE: 6
DATE: 2/9/2024
Speech therapist Hearing aid specialist Genetic counselor
Out-of-state telehealth providers must register biennially with DOH or the applicable board to provide
telehealth services, within the relevant scope of practice established by Florida law and rule, to patients
in this state. To register or renew registration as an out-of-state telehealth provider, the health care
professional must:
Hold an active and unencumbered license, which is substantially similar to a license issued to a
Florida practitioner in the same profession, in a U.S. state or jurisdiction and
Not have been subject to licensure disciplinary action during the five years before submission of
the registration application;
31
Not be subject to a pending licensure disciplinary investigation or action;
Not have had license revoked in any state or jurisdiction;
Designate a registered agent in this state for the service of process;
Maintain professional liability coverage or financial responsibility, which covers services
provided to patients not located in the provider’s home state, in the same amount as required for
Florida-licensed practitioners;
32
and
Prominently display a link to the DOH website, described below, which provides public
information on registered telehealth providers.
33
Telehealth Standards of Practice
A patient receiving telehealth services may be in any location at the time services are rendered and a
telehealth provider may be in any location when providing telehealth services to a patient. However, the
same standard of care applies regardless of physical location; current law sets the standard of care for
telehealth providers at the same level as the standard of care for health care practitioners providing in-
person health care services to patients in this state. This ensures that a patient receives the same
standard of care irrespective of the modality used by the health care practitioner to deliver the
services.
34
Practitioners may perform a patient evaluation using telehealth. A practitioner using telehealth is not
required to research a patient’s medical history or conduct a physical examination of the patient before
providing telehealth services to the patient if the telehealth provider is capable of conducting a patient
evaluation in a manner consistent with the applicable standard of care sufficient to diagnose and treat
the patient when using telehealth.
Current law does not contain health care practitioner-specific regulations for the use of telehealth.
Health care practitioners must adhere to the existing standard of care when providing services through
telehealth
35
and are subject to disciplinary action if they fail to do so.
36
Effect of the Bill
CS/HB 855 revises existing standards for the practice of dentistry and establishes new requirements
that specifically apply to providers using telehealth to provide dental services to patients.
Dental Practice
31
The bill requires DOH to consult the National Practitioner Data Bank to verify whether adverse information is available for the
registrant.
32
Florida law requires physicians, acupuncturists, chiropractic physicians, dentists, anesthesiologist assistants, advanced practice
registered nurses, and licensed midwives to demonstrate $100,000 per claim and an annual aggregate of $300,000 of professional
responsibility (see ss. 458.320 and 459.0085, F.S.; r. 64B1-12.001. F.A.C; r. 64B2-17.009, F.A.C.; 64B5-17.0105, F.A.C.; rr. 64B8-
31.006 and 64B15-7.006, F.A.C.; r. 64B9-4.002, F.A.C.; and r. 64B24-7.013, F.A.C.; respectively). Podiatric physicians must
demonstrate professional responsibility in the amount of $100,000 (see r. 64B18-14.0072, F.A.C.).
33
S. 456.47(4), F.S.
34
S. 456.47(2), F.S.
35
S. 456.47(2), F.S.
36
S. 456.47(4)(i), F.S. STORAGE NAME: h0855c.HHS PAGE: 7
DATE: 2/9/2024
The bill requires every dentist, including individuals or entities providing services through telehealth
(telehealth provider), to provide each of his or her patients with the dentist’s name, contact telephone
number, after-hours contact information for emergencies, and license information. A dentist who fails to
provide each patient with the name, contact telephone number, after-hours contact information for
emergencies, and, upon the patient’s request, the license information of each dentist who is providing
dental services, is subject to discipline.
The bill requires any partnership, corporation, or other business entity that advertises dental services to
designate a dentist of record with the BOD. Such partnership, corporation, or business entity must
provide each patient with the name, contact phone number, after-hours emergency contact information,
and, upon patient request, license information of the dentist of record. The bill requires the designated
dentist of record to have a full, active, and unencumbered license to practice dentistry, or be an out-of-
state telehealth provider registered with DOH.
The bill requires a dentist to perform an in-person examination on a patient, or review records from an
in-person examination of the patient from the last 12 months, before the dentist makes an initial
diagnosis and correction of a malposition of teeth, or the initial use of an orthodontic appliance. Failure
to adhere to this requirement constitutes grounds for discipline. This requirement would only impact
dentists providing services via telehealth, and would have the effect of eliminating direct-to-consumer
alignment business models, unless such businesses are able to incorporate in-person visits that satisfy
this requirement.
Dental Advertising
The bill regulates advertisements for certain dental services provided via telehealth, including:
The taking of an impression or the digital scanning
37
of the human tooth, teeth, or jaws by any
means or method, directly or indirectly;
Furnishing, supplying, constructing, reproducing, or repairing any prosthetic denture, bridge, or
appliance or any other structure designed to be worn in the human mouth;
Placing an appliance or a structure in the human mouth or adjusting or attempting to adjust the
appliance or structure; and
Correcting or attempting to correct malformations of teeth or jaws.
Advertisements for these services provided via telehealth must include a disclaimer that reads, in a
clearly legible font and size:
“An in-person examination with a dentist licensed under chapter 466, Florida
Statutes, is recommended before beginning telehealth treatment in order to
prevent injury or harm.”
This requirement applies to advertisements intended to solicit patients including, but not limited to,
business cards, circulars, pamphlets, newspapers, websites, and social media.
The provisions of the bill represent a significant departure from Florida’s current policies regarding
telehealth. Since telehealth was first recognized in statute in 2019,
38
Florida law has treated health care
services as equivalent, regardless of whether they are rendered in person or via telehealth. By
establishing requirements that apply exclusively to telehealth services, the bill creates a separate, more
stringent, regulatory standard for services provided via telehealth.
The bill provides an effective date of July 1, 2024.
B. SECTION DIRECTORY:
37
The bill defines “digital scanning” as the use of digital technology that creates a computer-generated replica of the hard
and soft tissue of the oral cavity using enhanced digital photography, lasers, or other optical scanning devices.
38
See, ch. 2019-137, L.O.F. STORAGE NAME: h0855c.HHS PAGE: 8
DATE: 2/9/2024
Section 1: Amends s. 466.003, F.S., relating to definitions.
Section 2: Amends s. 466.016, F.S., relating to license to be displayed.
Section 3: Amends s. 466.018, F.S., relating to dentist of record; patient records.
Section 4: Amends s. 466.019, F.S., relating to advertising by dentists
Section 5: Amends s. 466.028, F.S., relating to grounds for disciplinary action; action by the board.
Section 6: Provides an effective date of July 1, 2024.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
According to DOH, they will experience an increase in workload associated with additional
complaints, investigations, and prosecutions due to the provisions of this bill. DOH estimates a
need for an additional three full-time equivalent (FTE) positions in order to implement the provisions
of the bill.
39
The total estimated annual FTE cost of $386,117 consists of the following:
40
Salary and Benefits - $338,435/Recurring
Salary Rate – 237,580 Units of Rate/Recurring
Expense category - $26,625/Recurring + $19,977/Non-Recurring
Human Resources - $1,080/Recurring
DOH will also incur non-recurring costs associated with rulemaking and IT system updates, which
current budget authority is adequate to absorb.
41
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Businesses operating under the direct-to-consumer teeth aligner business model may experience a
significant negative economic impact due to the regulatory provisions of the bill.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
39
Supra, note 27.
40
Supra, note 27.
41
Supra, note 27. STORAGE NAME: h0855c.HHS PAGE: 9
DATE: 2/9/2024
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
DOH and the Board of Dentistry have sufficient rulemaking authority to implement the bill’s provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On February 8, 2024, the Health and Human Services Committee adopted an amendment to HB 855 and
reported the bill favorably as a committee substitute. The amendment:
Required any business entity that advertises dental services to designate a dentist of record with
the Board of Dentistry.
Deleted the section of the bill which restated the current law requiring that patients be designated a
dentist of record, and the related grounds for discipline.
Required a dentist to perform an in-person exam, or obtain and review records from an in-person
exam, within the last 12 months before the dentist makes an initial diagnosis and correction of a
malposition of teeth or an initial use of an orthodontic appliance for a patient.
The analysis is drafted to the bill as amended by the Health and Human Services Committee.