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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to dental therapy; amending s. 2
409.906, F.S.; authorizing Medicaid to reimburse for 3
dental services provided in a mobile dental unit that 4
is owned by, operated by, or contracted with a health 5
access setting or another similar setting or pro gram; 6
amending s. 466.001, F.S.; revising legislative 7
purpose and intent; amending s. 466.002, F.S.; 8
providing applicability; reordering and amending s. 9
466.003, F.S.; defining the terms "dental therapist" 10
and "dental therapy"; making technical changes; 11
amending s. 466.004, F.S.; requiring the chair of the 12
Board of Dentistry to appoint a Council on Dental 13
Therapy, effective after a specified timeframe; 14
providing for membership, meetings, and the purpose of 15
the council; amending s. 466.006, F.S.; revising th e 16
definitions of the terms "full -time practice" and 17
"full-time practice of dentistry within the geographic 18
boundaries of this state within 1 year" to include 19
full-time faculty members of certain dental therapy 20
schools; amending s. 466.009, F.S.; requiring the 21
Department of Health to allow any person who fails the 22
dental therapy examination to retake the examination; 23
providing that a person who fails a practical or 24
clinical examination to practice dental therapy and 25
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who has failed one part or procedure of th e 26
examination may be required to retake only that part 27
or procedure to pass the examination; amending s. 28
466.011, F.S.; requiring the board to certify an 29
applicant for licensure as a dental therapist; 30
creating s. 466.0136, F.S.; requiring the board to 31
require each licensed dental therapist to complete a 32
specified number of hours of continuing education; 33
requiring the board to adopt rules and guidelines; 34
authorizing the board to excuse licensees from 35
continuing education requirements in certain 36
circumstances; amending s. 466.016, F.S.; requiring a 37
practitioner of dental therapy to post and display her 38
or his license in each office where she or he 39
practices; amending s. 466.017, F.S.; requiring the 40
board to adopt certain rules relating to dental 41
therapists; authorizing a dental therapist under the 42
general supervision of a dentist to administer local 43
anesthesia and operate an X -ray machine, expose dental 44
X-ray films, and interpret or read such films if 45
specified requirements are met; correcting the 46
spelling of a term; amending s. 466.018, F.S.; 47
providing that a dentist of record remains primarily 48
responsible for the dental treatment of a patient 49
regardless of whether the treatment is provided by a 50
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dental therapist; requiring that the initials of a 51
dental therapist who renders treatment to a patient be 52
placed in the record of the patient; creating s. 53
466.0225, F.S.; providing application requirements and 54
examination and licensure qualifications for dental 55
therapists; creating s. 466.0227, F.S.; authorizing a 56
dental therapist to perform specified services under 57
the general supervision of a dentist under certain 58
conditions; specifying state -specific dental therapy 59
services; requiring that a collaborative management 60
agreement be signed by a supervising dentist and a 61
dental therapist and to include certain information; 62
requiring the supervising dentist to determine the 63
number of hours of practice that a dental therapist 64
must complete before performing certain authorized 65
services; authorizing a supervising dentist to 66
restrict or limit the dental therapist's practice in a 67
collaborative management agreement; providing that a 68
supervising dentist may authorize a dental therapist 69
to provide dental therapy services to a patient before 70
the dentist examines or diagnoses the patien t under 71
certain conditions; requiring a supervising dentist to 72
be licensed and practicing in this state; specifying 73
that the supervising dentist is responsible for 74
certain services; amending s. 466.026, F.S.; providing 75
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criminal penalties for practicing den tal therapy 76
without an active license, selling or offering to sell 77
a diploma from a dental therapy school or college, 78
falsely using a specified name or initials, or holding 79
oneself out as an actively licensed dental therapist; 80
amending s. 466.028, F.S.; re vising grounds for denial 81
of a license or disciplinary action to include the 82
practice of dental therapy; amending s. 466.0285, 83
F.S.; prohibiting persons other than licensed dentists 84
from employing a dental therapist in the operation of 85
a dental office and from controlling the use of any 86
dental equipment or material in certain circumstances; 87
requiring the department, in consultation with the 88
board and the Agency for Health Care Administration, 89
to provide reports to the Legislature by specified 90
dates; requiring that certain information and 91
recommendations be included in the reports; providing 92
an effective date. 93
94
Be It Enacted by the Legislature of the State of Florida: 95
96
Section 1. Paragraph (c) of subsection (1) of section 97
409.906, Florida Statutes, is amended, and paragraph (e) is 98
added to subsection (6) of that section, to read: 99
409.906 Optional Medicaid services. —Subject to specific 100
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appropriations, the agency may make payments for services which 101
are optional to the state under Title XIX of the So cial Security 102
Act and are furnished by Medicaid providers to recipients who 103
are determined to be eligible on the dates on which the services 104
were provided. Any optional service that is provided shall be 105
provided only when medically necessary and in accorda nce with 106
state and federal law. Optional services rendered by providers 107
in mobile units to Medicaid recipients may be restricted or 108
prohibited by the agency. Nothing in this section shall be 109
construed to prevent or limit the agency from adjusting fees, 110
reimbursement rates, lengths of stay, number of visits, or 111
number of services, or making any other adjustments necessary to 112
comply with the availability of moneys and any limitations or 113
directions provided for in the General Appropriations Act or 114
chapter 216. If necessary to safeguard the state's systems of 115
providing services to elderly and disabled persons and subject 116
to the notice and review provisions of s. 216.177, the Governor 117
may direct the Agency for Health Care Administration to amend 118
the Medicaid state plan to delete the optional Medicaid service 119
known as "Intermediate Care Facilities for the Developmentally 120
Disabled." Optional services may include: 121
(1) ADULT DENTAL SERVICES. — 122
(c) However, Medicaid will not provide reimbursement for 123
dental services provided in a mobile dental unit, except for a 124
mobile dental unit: 125
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1. Owned by, operated by, or having a contractual 126
agreement with the Department of Health and complying with 127
Medicaid's county health department clinic services program 128
specifications as a county health department clinic services 129
provider. 130
2. Owned by, operated by, or having a contractual 131
arrangement with a federally qualified health center and 132
complying with Medicaid's federally qualified health center 133
specifications as a federally qua lified health center provider. 134
3. Rendering dental services to Medicaid recipients, 21 135
years of age and older, at nursing facilities. 136
4. Owned by, operated by, or having a contractual 137
agreement with a state -approved dental educational institution. 138
5. Owned by, operated by, or having a contractual 139
agreement with a health access setting as defined in s. 466.003 140
or a similar setting or program. 141
(6) CHILDREN'S DENTAL SERVICES. —The agency may pay for 142
diagnostic, preventive, or corrective procedures, incl uding 143
orthodontia in severe cases, provided to a recipient under age 144
21, by or under the supervision of a licensed dentist. The 145
agency may also reimburse a health access setting as defined in 146
s. 466.003 for the remediable tasks that a licensed dental 147
hygienist is authorized to perform under s. 466.024(2). Services 148
provided under this program include treatment of the teeth and 149
associated structures of the oral cavity, as well as treatment 150
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of disease, injury, or impairment that may affect the oral or 151
general health of the individual. However, Medicaid will not 152
provide reimbursement for dental services provided in a mobile 153
dental unit, except for a mobile dental unit: 154
(e) Owned by, operated by, or having a contractual 155
agreement with a health access setting as defined in s. 466.003 156
or a similar setting or program. 157
Section 2. Section 466.001, Florida Statutes, is amended 158
to read: 159
466.001 Legislative purpose and intent. —The legislative 160
purpose for enacting this chapter is to ensure that every 161
dentist, dental therapist, or dental hygienist practicing in 162
this state meets minimum requirements for safe practice without 163
undue clinical interference by persons not licensed under this 164
chapter. It is the legislative intent that dental services be 165
provided only in accordance with the provisions of this chapter 166
and not be delegated to unauthorized individuals. It is the 167
further legislative intent that dentists , dental therapists, and 168
dental hygienists who fall below minimum competency or who 169
otherwise present a dan ger to the public shall be prohibited 170
from practicing in this state. All provisions of this chapter 171
relating to the practice of dentistry , dental therapy, and 172
dental hygiene shall be liberally construed to carry out such 173
purpose and intent. 174
Section 3. Subsections (5) and (6) of section 466.002, 175
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Florida Statutes, are amended to read: 176
466.002 Persons exempt from operation of chapter. —Nothing 177
in this chapter shall apply to the following practices, acts, 178
and operations: 179
(5) Students in Florida schools o f dentistry, dental 180
therapy, and dental hygiene or dental assistant educational 181
programs, while performing regularly assigned work under the 182
curriculum of such schools or programs. 183
(6) Instructors in Florida schools of dentistry, 184
instructors in dental pr ograms that prepare persons holding 185
D.D.S. or D.M.D. degrees for certification by a specialty board 186
and that are accredited in the United States by January 1, 2005, 187
in the same manner as the board recognizes accreditation for 188
Florida schools of dentistry t hat are not otherwise affiliated 189
with a Florida school of dentistry, or instructors in Florida 190
schools of dental hygiene or dental therapy or dental assistant 191
educational programs, while performing regularly assigned 192
instructional duties under the curricul um of such schools or 193
programs. A full-time dental instructor at a dental school or 194
dental program approved by the board may be allowed to practice 195
dentistry at the teaching facilities of such school or program, 196
upon receiving a teaching permit issued by t he board, in strict 197
compliance with such rules as are adopted by the board 198
pertaining to the teaching permit and with the established rules 199
and procedures of the dental school or program as recognized in 200
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this section. 201
Section 4. Section 466.003, Florid a Statutes, is reordered 202
and amended to read: 203
466.003 Definitions. —As used in this chapter , the term: 204
(1) "Board" means the Board of Dentistry. 205
(7)(2) "Dentist" means a person licensed to practice 206
dentistry pursuant to this chapter. 207
(8)(3) "Dentistry" means the healing art which is 208
concerned with the examination, diagnosis, treatment planning, 209
and care of conditions within the human oral cavity and its 210
adjacent tissues and structures. It includes the performance or 211
attempted performance of any denta l operation, or oral or oral -212
maxillofacial surgery and any procedures adjunct thereto, 213
including physical evaluation directly related to such operation 214
or surgery pursuant to hospital rules and regulations. It also 215
includes dental service of any kind gratu itously or for any 216
remuneration paid, or to be paid, directly or indirectly, to any 217
person or agency. The term "dentistry" shall also includes 218
include the following: 219
(a) The Taking of an impression of the human tooth, teeth, 220
or jaws directly or indirectl y and by any means or method. 221
(b) Supplying artificial substitutes for the natural teeth 222
or furnishing, supplying, constructing, reproducing, or 223
repairing any prosthetic denture, bridge, appliance, or any 224
other structure designed to be worn in the human mouth except on 225
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the written work order of a duly licensed dentist. 226
(c) The Placing of an appliance or structure in the human 227
mouth or the adjusting or attempting to adjust the same. 228
(d) Delivering the same to any person other than the 229
dentist upon whose work order the work was performed. 230
(e) Professing to the public by any method to furnish, 231
supply, construct, reproduce, or repair any prosthetic denture, 232
bridge, appliance, or other structure designed to be worn in the 233
human mouth. 234
(f) Diagnosing, prescribing, or treating or professing to 235
diagnose, prescribe, or treat disease, pain, deformity, 236
deficiency, injury, or physical condition of the human teeth or 237
jaws or oral-maxillofacial region. 238
(g) Extracting or attempting to extract human teeth. 239
(h) Correcting or attempting to correct malformations of 240
teeth or of jaws. 241
(i) Repairing or attempting to repair cavities in the 242
human teeth. 243
(3)(4) "Dental hygiene" means the rendering of 244
educational, preventive, and therapeutic dental services 245
pursuant to ss. 466.023 and 466.024 and any related extra -oral 246
procedure required in the performance of such services. 247
(4)(5) "Dental hygienist" means a person licensed to 248
practice dental hygiene pursuant to this chapter. 249
(2)(6) "Dental assistant" means a person , other than a 250
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dental hygienist, who, under the supervision and authorization 251
of a dentist, provides dental care services directly to a 252
patient. This term does shall not include a certified registered 253
nurse anesthetist licensed under part I of chapter 464. 254
(5) "Dental therapist" means a person licensed to practice 255
dental therapy pursuant to s. 466.0225. 256
(6) "Dental therapy" means the rendering of services 257
pursuant to s. 466.0227 and any related extraoral services or 258
procedures required in the performanc e of such services. 259
(9)(7) "Department" means the Department of Health. 260
(10)(8) "Direct supervision" means supervision whereby a 261
dentist diagnoses the condition to be treated, a dentist 262
authorizes the procedure to be performed, a dentist remains on 263
the premises while the procedures are performed, and a dentist 264
approves the work performed before dismissal of the patient. 265
(13)(9) "Indirect supervision" means supervision whereby a 266
dentist authorizes the procedure and a dentist is on the 267
premises while the procedures are performed. 268
(11)(10) "General supervision" means supervision whereby a 269
dentist authorizes the procedures which are being carried out 270
but need not be present when the authorized procedures are being 271
performed. The authorized procedures may also be performed at a 272
place other than the dentist's usual place of practice. The 273
issuance of a written work authorization to a commercial dental 274
laboratory by a dentist does not constitute general supervision. 275
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(14)(11) "Irremediable tasks" are those intraoral 276
treatment tasks which, when performed, are irreversible and 277
create unalterable changes within the oral cavity or the 278
contiguous structures or which cause an increased risk to the 279
patient. The administration of ane sthetics other than topical 280
anesthesia is considered to be an "irremediable task" for 281
purposes of this chapter. 282
(16)(12) "Remediable tasks" are those intraoral treatment 283
tasks which are reversible and do not create unalterable changes 284
within the oral cavity or the contiguous structures and which do 285
not cause an increased risk to the patient. 286
(15)(13) "Oral and maxillofac ial surgery" means the 287
specialty of dentistry involving diagnosis, surgery, and 288
adjunctive treatment of diseases, injuries, and defects 289
involving the functional and esthetic aspects of the hard and 290
soft tissues of the oral and maxillofacial regions. This t erm 291
may not be construed to apply to any individual exempt under s. 292
466.002(1). 293
(12)(14) "Health access setting" means a program or an 294
institution of the Department of Children and Families, the 295
Department of Health, the Department of Juvenile Justice, a 296
nonprofit community health center, a Head Start center, a 297
federally qualified health center or look -alike as defined by 298
federal law, a school -based prevention program, a clinic 299
operated by an accredited college of dentistry, or an accredited 300
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dental hygiene program in this state if such community service 301
program or institution immediately reports to the Board of 302
Dentistry all violations of s. 466.027, s. 466.028, or other 303
practice act or standard of care violations related to the 304
actions or inactions of a d entist, dental hygienist, or dental 305
assistant engaged in the delivery of dental care in such 306
setting. 307
(17)(15) "School-based prevention program" means 308
preventive oral health services offered at a school by one of 309
the entities described defined in subsection (12) (14) or by a 310
nonprofit organization that is exempt from federal income 311
taxation under s. 501(a) of the Internal Revenue Code, and 312
described in s. 501(c)(3) of the Internal Revenue Code. 313
Section 5. Subsection (2) of section 466.004, Florida 314
Statutes, is amended to read: 315
466.004 Board of Dentistry. — 316
(2) To advise the board, it is the intent of the 317
Legislature that councils be appointed as specified in 318
paragraphs (a)-(d) (a), (b), and (c). The department shall 319
provide administrative support to the councils and shall provide 320
public notice of meetings and agendas agenda of the councils. 321
Councils must shall include at least one board member , who shall 322
serve as chair, the council and must shall include nonboard 323
members. All council members shall be appointed by the board 324
chair. Council members shall be appointed for 4 -year terms, and 325
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all members are shall be eligible for reimbursement of expenses 326
in the manner of board members. 327
(a) A Council on Dental Hygiene shall be appointed by the 328
board chair and shall include one dental hygienist member of the 329
board, who shall chair the council, one dental member of the 330
board, and three dental hygienists who are actively engaged in 331
the practice of dental hygiene in this state. In making the 332
appointments, the chair shall consider recommendations from the 333
Florida Dental Hygiene Association. The council shall meet at 334
the request of the board chair, a majority of the members of the 335
board, or the council chair; however, the council must meet at 336
least three times a y ear. The council is charged with the 337
responsibility of and shall meet for the purpose of developing 338
rules and policies for recommendation to the board, which the 339
board shall consider, on matters pertaining to that part of 340
dentistry consisting of educationa l, preventive, or therapeutic 341
dental hygiene services; dental hygiene licensure, discipline, 342
or regulation; and dental hygiene education. Rule and policy 343
recommendations of the council must shall be considered by the 344
board at its next regularly scheduled m eeting in the same manner 345
in which it considers rule and policy recommendations from 346
designated subcommittees of the board. Any rule or policy 347
proposed by the board pertaining to the specified part of 348
dentistry identified defined by this subsection must shall be 349
referred to the council for a recommendation before final action 350
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by the board. The board may take final action on rules 351
pertaining to the specified part of dentistry identified defined 352
by this subsection without a council recommendation if the 353
council fails to submit a recommendation in a timely fashion as 354
prescribed by the board. 355
(b) A Council on Dental Assisting shall be appointed by 356
the board chair and shall include one board member who shall 357
chair the council and three dental assistants who are actively 358
engaged in dental assisting in this state. The council shall 359
meet at the request of the board chair or a majority of the 360
members of the board. The council shall meet for the purpose of 361
developing recommendations to the board on matters pertaining to 362
that part of dentistry related to dental assisting. 363
(c) Effective 28 months after the first dental therapy 364
license is granted by the board, the board chair shall appoint a 365
Council on Dental Therapy, which must include one board member 366
who shall chair the council and three dental therapists who are 367
actively engaged in the practice of dental therapy in this 368
state. The council shall meet at the request of the board chair, 369
a majority of the members of the board, or the council chair; 370
however, the council shall meet at least three times per year. 371
The council is charged with the responsibility of, and shall 372
meet for the purpose of, developing rules and policies for 373
recommendation to the board on matters pertaining to that part 374
of dentistry consisting of educ ational, preventive, or 375
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therapeutic dental therapy services; dental therapy licensure, 376
discipline, or regulation; and dental therapy education. Rule 377
and policy recommendations of the council must be considered by 378
the board at its next regularly scheduled m eeting in the same 379
manner in which it considers rule and policy recommendations 380
from designated subcommittees of the board. Any rule or policy 381
proposed by the board pertaining to the specified part of 382
dentistry identified by this subsection must be referre d to the 383
council for a recommendation before final action by the board. 384
The board may take final action on rules pertaining to the 385
specified part of dentistry identified by this subsection 386
without a council recommendation if the council fails to submit 387
a recommendation in a timely fashion as prescribed by the board. 388
(d) With the concurrence of the State Surgeon General, the 389
board chair may create and abolish other advisory councils 390
relating to dental subjects, including, but not limited to: 391
examinations, access to dental care, indigent care, nursing home 392
and institutional care, public health, disciplinary guidelines, 393
and other subjects as appropriate. Such councils shall be 394
appointed by the board chair and shall include at least one 395
board member who shall serve as chair. 396
Section 6. Paragraph (b) of subsection (4) and paragraph 397
(b) of subsection (6) of section 466.006, Florida Statutes, are 398
amended to read: 399
466.006 Examination of dentists. — 400
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(4) Notwithstanding any other provision of law in chapter 401
456 pertaining to the clinical dental licensure examination or 402
national examinations, to be licensed as a dentist in this 403
state, an applicant must successfully complete both of the 404
following: 405
(b) A practical or clinical examination, which must be the 406
American Dental Licensing Examination produced by the American 407
Board of Dental Examiners, Inc., or its successor entity, if 408
any, that is administered in this state, provided that the board 409
has attained, and continues to maintain thereafter, 410
representation on th e board of directors of the American Board 411
of Dental Examiners, the examination development committee of 412
the American Board of Dental Examiners, and such other 413
committees of the American Board of Dental Examiners as the 414
board deems appropriate by rule to a ssure that the standards 415
established herein are maintained organizationally. A passing 416
score on the American Dental Licensing Examination administered 417
in this state is valid for 365 days after the date the official 418
examination results are published. 419
1. As an alternative to such practical or clinical 420
examination, an applicant may submit scores from an American 421
Dental Licensing Examination previously administered in a 422
jurisdiction other than this state after October 1, 2011, and 423
such examination results must shall be recognized as valid for 424
the purpose of licensure in this state. A passing score on the 425
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American Dental Licensing Examination administered out of state 426
is shall be the same as the passing score for the American 427
Dental Licensing Examination admini stered in this state. The 428
examination results are valid for 365 days after the date the 429
official examination results are published. The applicant must 430
have completed the examination after October 1, 2011. This 431
subparagraph may not be given retroactive appl ication. 432
2. If the date of an applicant's passing American Dental 433
Licensing Examination scores from an examination previously 434
administered in a jurisdiction other than this state under 435
subparagraph 1. is older than 365 days, such scores are 436
nevertheless valid for the purpose of licensure in this state, 437
but only if the applicant demonstrates that all of the following 438
additional standards have been met: 439
a. The applicant completed the American Dental Licensing 440
Examination after October 1, 2011. This sub -subparagraph may not 441
be given retroactive application; 442
b. The applicant graduated from a dental school accredited 443
by the American Dental Association Commission on Dental 444
Accreditation or its successor entity, if any, or any other 445
dental accrediting organiz ation recognized by the United States 446
Department of Education. Provided, however, if the applicant did 447
not graduate from such a dental school, the applicant may submit 448
proof of having successfully completed a full -time supplemental 449
general dentistry progra m accredited by the American Dental 450
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Association Commission on Dental Accreditation of at least 2 451
consecutive academic years at such accredited sponsoring 452
institution. Such program must provide didactic and clinical 453
education at the level of a D.D.S. or D.M .D. program accredited 454
by the American Dental Association Commission on Dental 455
Accreditation. For purposes of this sub -subparagraph, a 456
supplemental general dentistry program does not include an 457
advanced education program in a dental specialty; 458
c. The applicant currently possesses a valid and active 459
dental license in good standing, with no restriction, which has 460
never been revoked, suspended, restricted, or otherwise 461
disciplined, from another state or territory of the United 462
States, the District of Columbi a, or the Commonwealth of Puerto 463
Rico; 464
d. The applicant submits proof that he or she has never 465
been reported to the National Practitioner Data Bank, the 466
Healthcare Integrity and Protection Data Bank, or the American 467
Association of Dental Boards Clearingh ouse. This sub-468
subparagraph does not apply if the applicant successfully 469
appealed to have his or her name removed from the data banks of 470
these agencies; 471
e.(I)(A) The applicant submits proof of having been 472
consecutively engaged in the full -time practice of dentistry in 473
another state or territory of the United States, the District of 474
Columbia, or the Commonwealth of Puerto Rico in the 5 years 475
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immediately preceding the date of application for licensure in 476
this state; or 477
(B) If the applicant has been licens ed in another state or 478
territory of the United States, the District of Columbia, or the 479
Commonwealth of Puerto Rico for less than 5 years, the applicant 480
submits proof of having been engaged in the full -time practice 481
of dentistry since the date of his or he r initial licensure. 482
(II) As used in this section, "full -time practice" is 483
defined as a minimum of 1,200 hours per year for each and every 484
year in the consecutive 5 -year period or, when applicable, the 485
period since initial licensure, and must include any combination 486
of the following: 487
(A) Active clinical practice of dentistry providing direct 488
patient care. 489
(B) Full-time practice as a faculty member employed by a 490
dental, dental therapy, or dental hygiene school approved by the 491
board or accredited by the American Dental Association 492
Commission on Dental Accreditation. 493
(C) Full-time practice as a student at a postgraduate 494
dental education program approved by the board or accredited by 495
the American Dental Association Commission on Dental 496
Accreditation. 497
(III) The board shall develop rules to determine what type 498
of proof of full-time practice is required and to recoup the 499
cost to the board of verifying full -time practice under this 500
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section. Such proof must, at a minimum, be: 501
(A) Admissible as evidence in an administrative 502
proceeding; 503
(B) Submitted in writing; 504
(C) Submitted by the applicant under oath with penalties 505
of perjury attached; 506
(D) Further documented by an affidavit of someone 507
unrelated to the applicant who is familiar with the applicant's 508
practice and testifies with particularity that the applicant has 509
been engaged in full -time practice; and 510
(E) Specifically found by the board to be both credible 511
and admissible. 512
(IV) An affidavit of only the applicant is not acceptable 513
proof of full-time practice unless it is further attested to by 514
someone unrelated to the applicant who has personal knowledge of 515
the applicant's practice. If the board deems it necessary to 516
assess credibility or accuracy, the board may require the 517
applicant or the applican t's witnesses to appear before the 518
board and give oral testimony under oath; 519
f. The applicant submits documentation that he or she has 520
completed, or will complete before he or she is licensed in this 521
state, continuing education equivalent to this state's 522
requirements for the last full reporting biennium; 523
g. The applicant proves that he or she has never been 524
convicted of, or pled nolo contendere to, regardless of 525
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adjudication, any felony or misdemeanor related to the practice 526
of a health care profession in any jurisdiction; 527
h. The applicant has successfully passed a written 528
examination on the laws and rules of this state regulating the 529
practice of dentistry and the computer -based diagnostic skills 530
examination; and 531
i. The applicant submits documentatio n that he or she has 532
successfully completed the applicable examination administered 533
by the Joint Commission on National Dental Examinations or its 534
successor organization. 535
(6) 536
(b)1. As used in this section, "full -time practice of 537
dentistry within the geo graphic boundaries of this state within 538
1 year" is defined as a minimum of 1,200 hours in the initial 539
year of licensure, which must include any combination of the 540
following: 541
a. Active clinical practice of dentistry providing direct 542
patient care within th e geographic boundaries of this state. 543
b. Full-time practice as a faculty member employed by a 544
dental, dental therapy, or dental hygiene school approved by the 545
board or accredited by the American Dental Association 546
Commission on Dental Accreditation and located within the 547
geographic boundaries of this state. 548
c. Full-time practice as a student at a postgraduate 549
dental education program approved by the board or accredited by 550
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the American Dental Association Commission on Dental 551
Accreditation and located wi thin the geographic boundaries of 552
this state. 553
2. The board shall develop rules to determine what type of 554
proof of full-time practice of dentistry within the geographic 555
boundaries of this state for 1 year is required in order to 556
maintain active licensure and shall develop rules to recoup the 557
cost to the board of verifying maintenance of such full -time 558
practice under this section. Such proof must, at a minimum: 559
a. Be admissible as evidence in an administrative 560
proceeding; 561
b. Be submitted in writing; 562
c. Be submitted by the applicant under oath with penalties 563
of perjury attached; 564
d. Be further documented by an affidavit of someone 565
unrelated to the applicant who is familiar with the applicant's 566
practice and testifies with particularity that the applican t has 567
been engaged in full -time practice of dentistry within the 568
geographic boundaries of this state within the last 365 days; 569
and 570
e. Include such additional proof as specifically found by 571
the board to be both credible and admissible. 572
3. An affidavit of only the applicant is not acceptable 573
proof of full-time practice of dentistry within the geographic 574
boundaries of this state within 1 year, unless it is further 575
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attested to by someone unrelated to the applicant who has 576
personal knowledge of the applicant 's practice within the last 577
365 days. If the board deems it necessary to assess credibility 578
or accuracy, the board may require the applicant or the 579
applicant's witnesses to appear before the board and give oral 580
testimony under oath. 581
Section 7. Subsection (1) of section 466.009, Florida 582
Statutes, is amended, and subsection (4) is added to that 583
section, to read: 584
466.009 Reexamination. — 585
(1) The department shall allow permit any person who fails 586
an examination that which is required under s. 466 .006, or s. 587
466.007, or s. 466.0225 to retake the examination. If the 588
examination to be retaken is a practical or clinical 589
examination, the applicant must shall pay a reexamination fee 590
set by rule of the board in an amount not to exceed the original 591
examination fee. 592
(4) If an applicant for a license to practice dental 593
therapy fails the practical or clinical examination and she or 594
he has failed only one part or procedure of such examination, 595
she or he may be required to retake only that part or procedure 596
to pass such examination. However, if any such applicant fails 597
more than one part or procedure of any such examination, she or 598
he must be required to retake the entire examination. 599
Section 8. Section 466.011, Florida Statutes, is amended 600
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to read: 601
466.011 Licensure.—The board shall certify for licensure 602
by the department any applicant who satisfies the requirements 603
of s. 466.006, s. 466.0067, or s. 466.007, or s. 466.0225. The 604
board may refuse to certify an applicant who has violated any of 605
the provisions of s. 466.026 or s. 466.028. 606
Section 9. Section 466.0136, Florida Statutes, is created 607
to read: 608
466.0136 Continuing education; dental therapists. —In 609
addition to any other requirements for relicensure for dental 610
therapists specified in this chapter , the board shall require 611
each licensed dental therapist to complete at least 24 hours, 612
but not more than 36 hours, biennially of continuing education 613
in dental subjects in programs approved by the board or in 614
equivalent programs of continuing education. P rograms of 615
continuing education approved by the board must be programs of 616
learning which, in the opinion of the board, contribute directly 617
to the dental education of the dental therapist. An individual 618
who is licensed as both a dental therapist and a denta l 619
hygienist may use 2 hours of continuing education that is 620
approved for both dental therapy and dental hygiene education to 621
satisfy both dental therapy and dental hygiene continuing 622
education requirements. The board shall adopt rules and 623
guidelines to administer and enforce this section. The dental 624
therapist shall retain in her or his records any receipts, 625
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vouchers, or certificates necessary to document completion of 626
the continuing education. Compliance with the continuing 627
education requirements is mandato ry for issuance of the renewal 628
certificate. The board may excuse licensees, as a group or as 629
individuals, from all or part of the continuing education 630
requirements if an unusual circumstance, emergency, or hardship 631
prevented compliance with this section. 632
Section 10. Section 466.016, Florida Statutes, is amended 633
to read: 634
466.016 License to be displayed. —Every practitioner of 635
dentistry, dental therapy, or dental hygiene within the meaning 636
of this chapter shall post and keep conspicuously displayed her 637
or his license in the office where wherein she or he practices, 638
in plain sight of the practitioner's patients. Any dentist , 639
dental therapist, or dental hygienist who practices at more than 640
one location shall be required to display a copy of her or his 641
license in each office where she or he practices. 642
Section 11. Present subsections (7) through (15) of 643
section 466.017, Florida Statutes, are redesignated as 644
subsections (8) through (16), respectively, a new subsection (7) 645
is added to that section, and paragraphs (d) and (e) of 646
subsection (3), subsection (4), and present subsections (7), 647
(8), and (14) of that section are amended, to read: 648
466.017 Prescription of drugs; anesthesia. — 649
(3) The board shall adopt rules which: 650
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(d) Establish further requirements relating to the use of 651
general anesthesia or sedation, including, but not limited to, 652
office equipment and the training of dental assistants , dental 653
therapists, or dental hygienists who work with dentists using 654
general anesthesia or sedation. 655
(e) Establish an administrative mechanism enabling the 656
board to verify compliance with training, education, experience, 657
equipment, or certification requirements o f dentists, dental 658
therapists, dental hygienists, and dental assistants adopted 659
pursuant to this subsection. The board may charge a fee to 660
defray the cost of verifying compliance with requirements 661
adopted pursuant to this paragraph. 662
(4) A dentist, dental therapist, or dental hygienist who 663
administers or employs the use of any form of anesthesia must 664
possess a certification in either basic cardiopulmonary 665
resuscitation for health professionals or advanced cardiac life 666
support approved by the American Heart Association or the 667
American Red Cross or an equivalent agency -sponsored course with 668
recertification every 2 years. Each dental office that which 669
uses any form of anesthesia must have immediately available and 670
in good working order such resuscitative equip ment, oxygen, and 671
other resuscitative drugs as are specified by rule of the board 672
in order to manage possible adverse reactions. 673
(7) A dental therapist, under the general supervision of a 674
dentist, may administer local anesthesia, including intraoral 675
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block anesthesia or soft tissue infiltration anesthesia if she 676
or he has completed the course described in subsection (5) and 677
presents evidence of current certification in basic or advanced 678
cardiac life support. 679
(8)(7) A licensed dentist, or a dental therapi st who is 680
authorized by her or his supervising dentist, may operate 681
utilize an X-ray machine, expose dental X -ray films, and 682
interpret or read such films. Notwithstanding The provisions of 683
part IV of chapter 468 to the contrary notwithstanding , a 684
licensed dentist, or a dental therapist who is authorized by her 685
or his supervising dentist, may authorize or direct a dental 686
assistant to operate such equipment and expose such films under 687
her or his direction and supervision, pursuant to rules adopted 688
by the board in accordance with s. 466.024 which ensure that the 689
said assistant is competent by reason of training and experience 690
to operate the X-ray said equipment in a safe and efficient 691
manner. The board may charge a fee not to exceed $35 to defray 692
the cost of verifying compliance with requirements adopted 693
pursuant to this section. 694
(9)(8) Notwithstanding The provisions of s. 465.0276 695
notwithstanding, a dentist need not register with the board or 696
comply with the continuing education requirements of that 697
section if the dentist confines her or his dispensing activity 698
to the dispensing of fluorides and chlorhexidine chlorohexidine 699
rinse solutions; provid ed that the dentist complies with and is 700
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subject to all laws and rules applicable to pharmacists and 701
pharmacies, including, but not limited to, chapters 465, 499, 702
and 893, and all applicable federal laws and regulations, when 703
dispensing such products. 704
(15)(14) As used in subsections (10)-(14) (9)-(13), the 705
term "adverse incident" means any mortality that occurs during 706
or as the result of a dental procedure, or an incident that 707
results in a temporary or permanent physical or mental injury 708
that requires hospitalization or emergency room treatment of a 709
dental patient which occurs during or as a direct result of the 710
use of general anesthesia, deep sedation, moderate sedation, 711
pediatric moderate sedation, oral sedation, minimal sedation 712
(anxiolysis), nitrous ox ide, or local anesthesia. 713
Section 12. Subsection (1) of section 466.018, Florida 714
Statutes, is amended to read: 715
466.018 Dentist of record; patient records. — 716
(1) Each patient must shall have a dentist of record. The 717
dentist of record shall remain pri marily responsible for all 718
dental treatment on such patient regardless of whether the 719
treatment is rendered by that the dentist or by another dentist, 720
a dental therapist, a dental hygienist, or a dental assistant 721
rendering such treatment in conjunction wit h, at the direction 722
or request of, or under the supervision of such dentist of 723
record. The dentist of record must shall be identified in the 724
record of the patient. If treatment is rendered by a dentist 725
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other than the dentist of record or by a dental hygien ist, 726
dental therapist, or dental assistant, the name or initials of 727
such person must shall be placed in the record of the patient. 728
In any disciplinary proceeding brought pursuant to this chapter 729
or chapter 456, it must shall be presumed as a matter of law 730
that treatment was rendered by the dentist of record unless 731
otherwise noted on the patient record pursuant to this section. 732
The dentist of record and any other treating dentist are subject 733
to discipline pursuant to this chapter or chapter 456 for 734
treatment rendered to the patient and performed in violation of 735
such chapter. One of the purposes of this section is to ensure 736
that the responsibility for each patient is assigned to one 737
dentist in a multidentist practice of any nature and to assign 738
primary responsibility to the dentist for treatment rendered by 739
a dental hygienist, dental therapist, or dental assistant under 740
her or his supervision. This section may shall not be construed 741
to assign any responsibility to a dentist of record for 742
treatment rendered purs uant to a proper referral to another 743
dentist who does not in practice with the dentist of record or 744
to prohibit a patient from voluntarily selecting a new dentist 745
without permission of the dentist of record. 746
Section 13. Section 466.0225, Florida Statut es, is created 747
to read: 748
466.0225 Examination of dental therapists; licensing. — 749
(1) Any person desiring to be licensed as a dental 750
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therapist must apply to the department to take the licensure 751
examinations and shall verify the information required on the 752
application by oath. The application must include two recent 753
photographs of the applicant. 754
(2) An applicant is entitled to take the examinations 755
required under this section and receive licensure to practice 756
dental therapy in this state if the applicant meets all of the 757
following criteria: 758
(a) Is 18 years of age or older. 759
(b) Is a graduate of a dental therapy college or school 760
accredited by the American Dental Association Commission on 761
Dental Accreditation or its successor entity, if any, or any 762
other dental therapy accrediting entity recognized by the United 763
States Department of Education. For applicants applying for a 764
dental therapy license before January 1, 2029, the board must 765
approve the applicant's dental therapy education program if the 766
program was administered by a college or school that operates an 767
accredited dental or dental hygiene program and the college or 768
school certifies to the board that the applicant's education 769
substantially conformed to the education standards established 770
by the American Dental Association Commission on Dental 771
Accreditation or its successor entity. 772
(c) Has successfully completed a dental therapy practical 773
or clinical examination produced by the American Board of Dental 774
Examiners, Inc., (ADEX) or its successor entity, if any, if the 775
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board finds that the successor entity's examination meets or 776
exceeds the requirements of this section. If an applicant fails 777
to pass such an examination after three attempts, the applicant 778
is not eligible to retake the examination unless th e applicant 779
completes additional education requirements as specified by the 780
board. If a dental therapy examination has not been established 781
by ADEX, the board must administer or approve an alternative 782
examination. 783
(d) Has not been disciplined by a board, except for 784
citation offenses or minor violations. 785
(e) Has not been convicted of or pled nolo contendere to, 786
regardless of adjudication, any felony or misdemeanor related to 787
the practice of a health care profession. 788
(f) Has successfully completed a wri tten examination on 789
the laws and rules of this state regulating the practice of 790
dental therapy. 791
(3) An applicant who meets the requirements of this 792
section and who has successfully completed an examination 793
identified in paragraph (2)(c) in a jurisdiction other than this 794
state, or who has successfully completed a comparable 795
examination administered or approved by the licensing authority 796
in a jurisdiction other than this state, must be licensed to 797
practice dental therapy in this state if the board determine s 798
that the other jurisdiction's examination is substantially 799
similar to those identified in paragraph (2)(c). 800
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Section 14. Section 466.0227, Florida Statutes, is created 801
to read: 802
466.0227 Dental therapists; scope and area of practice. — 803
(1) Except as otherwise provided in this chapter, a dental 804
therapist may perform the dental therapy services specified in 805
subsection (2) under the general supervision of a dentist to the 806
extent authorized by the supervising dentist and provided within 807
the terms of a written collaborative management agreement signed 808
by the dental therapist and the supervising dentist which meets 809
the requirements of subsection (3). 810
(2) Dental therapy services include all of the following: 811
(a) All services, treatments, and competencies identified 812
by the American Dental Association Commission on Dental 813
Accreditation in the commission's Accreditation Standards for 814
Dental Therapy Education Programs. 815
(b) The following state -specific services, if the dental 816
therapist's education included c urriculum content satisfying the 817
American Dental Association Commission on Dental Accreditation 818
criteria for state-specific dental therapy services: 819
1. Evaluating radiographs. 820
2. Placement of space maintainers. 821
3. Pulpotomies on primary teeth. 822
4. Dispensing and administering nonopioid analgesics, 823
including nitrous oxide, anti -inflammatories, and antibiotics, 824
as authorized by the supervising dentist and within the 825
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parameters of the collaborative management agreement. 826
5. Oral evaluation and assessme nt of dental disease and 827
formulation of an individualized treatment plan if authorized by 828
the supervising dentist and subject to any conditions, 829
limitations, and protocols specified by the supervising dentist 830
in the collaborative management agreement. 831
(3) Before performing any of the services authorized in 832
subsection (2), a dental therapist must enter into a written 833
collaborative management agreement with a supervising dentist. 834
The agreement must be signed by the dental therapist and the 835
supervising dentist and must include all of the following 836
information: 837
(a) Practice settings where services may be provided by 838
the dental therapist and the populations to be served by the 839
dental therapist. 840
(b) Any limitations on the services that may be provided 841
by the dental therapist, including the level of supervision 842
required by the supervising dentist. This may include 843
telehealth. 844
(c) Age-specific and procedure -specific practice protocols 845
for the dental therapist, including case selection criteria, 846
assessment guidelines, and imaging frequency. 847
(d) A procedure for creating and maintaining dental 848
records for the patients who are treated by the dental 849
therapist. 850
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(e) A plan to manage medical emergencies in each practice 851
setting where the dental therapist provides care. 852
(f) A quality assurance plan for monitoring care provided 853
by the dental therapist, including patient care review, referral 854
follow-up, and a quality assurance chart review. 855
(g) Protocols for the dental therapist to administer and 856
dispense medications, including the specific conditions and 857
circumstances under which the medications are to be dispensed 858
and administered. 859
(h) Criteria relating to the provision of care by the 860
dental therapist to patients with specific medical conditions or 861
complex medication histories, including requirements for 862
consultation before the initiation of care. 863
(i) Supervision criteria of dental therapists. 864
(j) A plan for the provision of clinical resources and 865
referrals in situations that are beyond the capabilities of t he 866
dental therapist. 867
(4) A supervising dentist shall determine the number of 868
hours of practice that a dental therapist must complete under 869
direct or indirect supervision of the supervising dentist before 870
the dental therapist may perform any of the servic es authorized 871
in subsection (2) under general supervision. 872
(5) A supervising dentist may restrict or limit the dental 873
therapist's practice in the written collaborative management 874
agreement to be less than the full scope of practice for dental 875
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therapists which is authorized in subsection (2). 876
(6) A supervising dentist may authorize a dental therapist 877
to provide dental therapy services to a patient before the 878
supervising dentist examines or diagnoses the patient if the 879
authority, conditions, and protocols are established in a 880
written collaborative management agreement and if the patient is 881
subsequently referred to a dentist for any needed additional 882
services that exceed the dental therapist's scope of practice or 883
authorization under the collaborative manag ement agreement. 884
(7) A supervising dentist must be licensed and practicing 885
in this state. The supervising dentist is responsible for all 886
services authorized and performed by the dental therapist 887
pursuant to the collaborative management agreement and for 888
providing or arranging follow -up services to be provided by a 889
dentist for any additional services that exceed the dental 890
therapist's scope of practice or authorization under the 891
collaborative management agreement. 892
Section 15. Section 466.026, Florida S tatutes, is amended 893
to read: 894
466.026 Prohibitions; penalties. — 895
(1) Each of the following acts constitutes a felony of the 896
third degree, punishable as provided in s. 775.082, s. 775.083, 897
or s. 775.084: 898
(a) Practicing dentistry , dental therapy, or dental 899
hygiene unless the person has an appropriate, active license 900
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issued by the department pursuant to this chapter. 901
(b) Using or attempting to use a license issued pursuant 902
to this chapter which license has been suspended or revoked. 903
(c) Knowingly emplo ying any person to perform duties 904
outside the scope allowed such person under this chapter or the 905
rules of the board. 906
(d) Giving false or forged evidence to the department or 907
board for the purpose of obtaining a license. 908
(e) Selling or offering to sell a diploma conferring a 909
degree from a dental college , or dental hygiene school or 910
college, or dental therapy school or college, or a license 911
issued pursuant to this chapter, or procuring such diploma or 912
license with intent that it will shall be used as evidence of 913
that which the document stands for, by a person other than the 914
one upon whom it was conferred or to whom it was granted. 915
(2) Each of the following acts constitutes a misdemeanor 916
of the first degree, punishable as provided in s. 775.082 or s. 917
775.083: 918
(a) Using the name or title "dentist," the letters 919
"D.D.S." or "D.M.D.", or any other words, letters, title, or 920
descriptive matter which in any way represents a person as being 921
able to diagnose, treat, prescribe, or operate for any disease, 922
pain, deformity, deficiency, injury, or physical condition of 923
the teeth or jaws or oral -maxillofacial region unless the person 924
has an active dentist's license issued by the department 925
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pursuant to this chapter. 926
(b) Using the name "dental hygienist" or the initia ls 927
"R.D.H." or otherwise holding herself or himself out as an 928
actively licensed dental hygienist or implying to any patient or 929
consumer that she or he is an actively licensed dental hygienist 930
unless that person has an active dental hygienist's license 931
issued by the department pursuant to this chapter. 932
(c) Using the name "dental therapist" or the initials 933
"D.T." or otherwise holding herself or himself out as an 934
actively licensed dental therapist or implying to any patient or 935
consumer that she or he is an a ctively licensed dental therapist 936
unless that person has an active dental therapist's license 937
issued by the department pursuant to this chapter. 938
(d) Presenting as her or his own the license of another. 939
(e)(d) Knowingly concealing information relative t o 940
violations of this chapter. 941
(f)(e) Performing any services as a dental assistant as 942
defined herein, except in the office of a licensed dentist, 943
unless authorized by this chapter or by rule of the board. 944
Section 16. Paragraphs (b), (c), (g), (s), an d (t) of 945
subsection (1) of section 466.028, Florida Statutes, are amended 946
to read: 947
466.028 Grounds for disciplinary action; action by the 948
board.— 949
(1) The following acts constitute grounds for denial of a 950
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license or disciplinary action, as specified in s. 456.072(2): 951
(b) Having a license to practice dentistry , dental 952
therapy, or dental hygiene revoked, suspended, or otherwise 953
acted against, including the denial of licensure, by the 954
licensing authority of another state, territory, or country. 955
(c) Being convicted or found guilty of or entering a plea 956
of nolo contendere to, regardless of adjudication, a crime in 957
any jurisdiction which relates to the practice of dentistry , 958
dental therapy, or dental hygiene. A plea of nolo contendere 959
creates shall create a rebuttable presumption of guilt to the 960
underlying criminal charges. 961
(g) Aiding, assisting, procuring, or advising any 962
unlicensed person to practice dentistry , dental therapy, or 963
dental hygiene contrary to this chapter or to a rule of the 964
department or the board. 965
(s) Being unable to practice her or his profession with 966
reasonable skill and safety to patients by reason of illness or 967
use of alcohol, drugs, narcotics, chemicals, or any other type 968
of material or as a result of any mental or physical conditio n. 969
In enforcing this paragraph, the department shall have, upon a 970
finding of the State Surgeon General or her or his designee that 971
probable cause exists to believe that the licensee is unable to 972
practice dentistry, dental therapy, or dental hygiene because of 973
the reasons stated in this paragraph, has the authority to issue 974
an order to compel a licensee to submit to a mental or physical 975
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examination by physicians designated by the department. If the 976
licensee refuses to comply with such order, the department's 977
order directing such examination may be enforced by filing a 978
petition for enforcement in the circuit court where the licensee 979
resides or does business. The licensee against whom the petition 980
is filed may shall not be named or identified by initials in any 981
public court records or documents, and the proceedings must 982
shall be closed to the public. The department is shall be 983
entitled to the summary procedure provided in s. 51.011. A 984
licensee affected under this paragraph must shall at reasonable 985
intervals be afforded an opportunity to demonstrate that she or 986
he can resume the competent practice of her or his profession 987
with reasonable skill and safety to patients. 988
(t) Fraud, deceit, or misconduct in the practice of 989
dentistry, dental therapy, or dental hygiene. 990
Section 17. Paragraphs (a) and (b) of subsection (1) of 991
section 466.0285, Florida Statutes, are amended to read: 992
466.0285 Proprietorship by nondentists. — 993
(1) No person other than a dentist licensed pursuant to 994
this chapter, nor any entity other than a professional 995
corporation or limited liability company composed of dentists, 996
may: 997
(a) Employ a dentist , a dental therapist, or a dental 998
hygienist in the operation of a dental office. 999
(b) Control the use of any dental e quipment or material 1000
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while such equipment or material is being used for the provision 1001
of dental services, whether those services are provided by a 1002
dentist, a dental therapist, a dental hygienist, or a dental 1003
assistant. 1004
1005
Any lease agreement, rental agreemen t, or other arrangement 1006
between a nondentist and a dentist whereby the nondentist 1007
provides the dentist with dental equipment or dental materials 1008
shall contain a provision whereby the dentist expressly 1009
maintains complete care, custody, and control of the eq uipment 1010
or practice. 1011
Section 18. The Department of Health, in consultation with 1012
the Board of Dentistry and the Agency for Health Care 1013
Administration, shall submit a progress report to the President 1014
of the Senate and the Speaker of the House of Represen tatives by 1015
July 1, 2027, and a final report 4 years after the first dental 1016
therapy license is issued. The reports must include all of the 1017
following information and recommendations: 1018
(1) The progress that has been made in this state to 1019
implement dental the rapy training programs, licensing, and 1020
Medicaid reimbursement. 1021
(2) Data demonstrating the effects of dental therapy in 1022
this state on all of the following: 1023
(a) Patient access to dental services. 1024
(b) Costs to dental providers, patients, dental insuranc e 1025
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carriers, and the state. 1026
(c) The quality and safety of dental services. 1027
(3) Specific recommendations for any necessary 1028
legislative, administrative, or regulatory reform relating to 1029
the practice of dental therapy. 1030
(4) Any other information the department deems 1031
appropriate. 1032
Section 19. This act shall take effect July 1, 2024. 1033