The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Appropriations Committee on Health and Human Services
BILL: SB 302
INTRODUCER: Senator Boyd
SUBJECT: Dental Services
DATE: January 23, 2024
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto Van
Winkle
Brown
HP
Favorable
2. Gerbrandt McKnight AHS Favorable
3. FP
I. Summary:
SB 302 requires dentists and any individual, partnership, corporation, or other entity that
provides dental services through telehealth to make available the dentist’s name, telephone
number, after-hours contact information for emergencies, and upon request, licensure
information to patients.
The bill requires the dentist of record to remain primarily responsible for all dental treatment for
any patient who is treated through telehealth, whether care is rendered by the dentist of record,
another dentist, dental hygienist, or dental assistant.
The bill creates a definition for advertisement, and requires that an advertisement for dental
services provided through telehealth must include a specific disclaimer that an in-person
examination with a dentist is recommended before certain services are performed.
The bill creates a standard that would require a dentist of record to perform an in-person
examination of a patient or obtain records from an in-person examination within the last six
months before the initial diagnosis and correction of a malposition of human teeth or initial use
of an orthodontic appliance.
The bill has an indeterminate, yet significant negative fiscal impact on the Department of Health,
however, current resources are adequate to absorb these costs. See Section V. Fiscal Impact
Statement.
The bill takes effect July 1, 2024.
REVISED: BILL: SB 302 Page 2
II. Present Situation:
The Practice of Dentistry
The Board of Dentistry (BOD), within the Department of Health (DOH), regulates the practice of
dentistry 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
License Display Requirements
Every dentist or 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. Any dentist
or dental hygienist who practices at more than one location shall be required to display a copy of
his or her license in each location where she or he practices.
4
Dental Patient Records
Every dentist must maintain written dental records and medical history records on every patient
which must justify the dentist’s course of treatment for the patient. The records must include, but
not be limited to:
Patient history:
Examination results;
Test results; and,
X rays, if taken.
5
In a multi-dentist practice, the owner dentist(s) must maintain either the original or duplicates of
all patient records, including dental charts, patient histories, examination and test results, study
models, and X rays, of any patient treated by a dentist at the owner dentist’s practice facility for
four years from the date of the last patient’s visit.
6
The owner dentist(s) of a multi-dentist
practice may be relieved of this responsibility if, upon request of the patient or the patient’s legal
representative, the dentist transfers custody of the records to another dentist, the patient, or the
patient’s legal representative and retains, in lieu of the records, a written statement, signed by the
owner dentist, the person who received the records, and two witnesses, that lists the date, the
records that were transferred and the persons to whom the records were transferred. The owner
dentist(s) must provide reasonable access to duplicate records at cost.
7
Dentist of Record
Section 466.018, F.S., requires that each dental patient shall have a dentist of record. The dentist
of record must remain primarily responsible for all dental treatment on a patient regardless of
1
Section 466.004, F.S.
2
Section 466.003(3), F.S.
3
Section 466.003(4) and (5), F.S.
4
Section 466.016, F.S.
5
Section 466.018 (3), F.S.
6
Section 466.018(5), F.S.
7
Section 466.018(4), F.S. BILL: SB 302 Page 3
whether the treatment is rendered by the dentist or by another dentist, dental hygienist, or dental
assistant rendering such treatment in conjunction with, at the direction or request of, or under the
supervision of such dentist of record. The dentist of record must be identified in the record of the
patient. If treatment is rendered by a dentist other than the dentist of record or by a dental
hygienist or assistant, the name or initials of such person must be placed in the record of the
patient. In any disciplinary proceeding against a dentist, it is presumed as a matter of law that
treatment was rendered by the dentist of record unless otherwise noted on the patient record.
8
Section 466.028, F.S., sets forth the offenses that constitute grounds for disciplinary action by
the BOD. Currently, failure by the dentist of record to perform an in-person exam or obtain
records from an in-person exam within the last 6 months, before the initial diagnosis and
correction of a malposition of teeth or the initial use of an orthodontic appliance, does not
constitute grounds for disciplinary action by the Board.
Delegation of Duties
A dentist may not delegate irremediable tasks to a dental hygienist or dental assistant, except as
provided by law. A dentist may delegate remediable tasks to a dental hygienist or dental assistant
when such tasks pose no risk to the patient. A dentist may only delegate remediable tasks so
defined by law or BOD rule.
9
The BOD designates by rule which tasks are remediable and delegable, except that the following
are found by law to be remediable and delegable:
Taking impressions for study casts but not for the purpose of fabricating any intraoral
restorations or orthodontic appliance;
Placing periodontal dressings;
Removing periodontal or surgical dressings;
Removing sutures;
Placing or removing rubber dams;
Placing or removing matrices;
Placing or removing temporary restorations;
Applying cavity liners, varnishes, or bases;
Polishing amalgam restorations;
Polishing clinical crowns of the teeth for the purpose of removing stains but not changing the
existing contour of the tooth;
Obtaining bacteriological cytological specimens not involving cutting of the tissue; and
Administering local anesthesia.
10
All other remediable tasks must be performed under the direct, indirect, or general supervision of
a dentist, after such additional training as required by BOD rule.
11
8
Section 466.018,(1), F.S.
9
Section 466.024, (1), F.S.
10
Id.
11
Section 466.024(7), F.S. BILL: SB 302 Page 4
A dentist may not delegate to anyone other than another licensed dentist:
Any prescription of drugs or medications requiring the written order or prescription of a
licensed dentist or physician; or
Any diagnosis for treatment or treatment planning.
12
Dental Advertising
A licensed dentist’s advertisements may not contain any false, fraudulent, misleading, or
deceptive statement or claim or any statement or claim which:
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;
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.
13
Telehealth
Section 456.47, F.S., defines the term “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. The term does not include e-mail messages or facsimile
transmissions.
In a general sense, “synchronous” telehealth happens in live, real-time settings where the patient
interacts with a provider, usually via phone or video. Providers and patients communicate
directly, often resulting in a diagnosis, treatment plan, or prescription. Synchronous telehealth
can include additional at-home devices such as a blood pressure or heart rate monitors,
thermometers, oximeters, cameras, or scales to help the provider more accurately assess the
patient’s health status.
14
12
Section 466.024(8), F.S.
13
Section 466.019, F.S.
14
TELEHEALTH.HHS.GOV, “Synchronous direct-to-consumer telehealth,” available at
https://telehealth.hhs.gov/providers/direct-to-consumer/synchronous-direct-to-consumer-telehealth/ (last visited Jan. 10,
2024). BILL: SB 302 Page 5
“Asynchronous” telehealth, also known as “store-and-forward,” is often used for patient intake
or follow-up care. For example, a patient sends a photo of a skin condition that is later reviewed
by a dermatologist who recommends treatment.
15
Section 456.47, F.S., also authorizes out-of-state health care providers to use telehealth to deliver
health care services to Florida patients if they register with the DOH or the applicable board
16
and meet certain eligibility requirements.
17
A registered out-of-state telehealth provider may use
telehealth, within the relevant scope of practice established by Florida law and rule, to provide
health care services to Florida patients but is prohibited from opening an office in Florida and
from providing in-person health care services to patients located in Florida
18
without first
becoming licensed by the state of Florida.
A telehealth provider must document in the patient’s medical record the health care services
rendered using telehealth according to the same standard as used for in-person services. Medical
records, including video, audio, electronic, or other records generated as a result of providing
such services, are confidential pursuant to ss. 395.3025(4), and 456.057, F.S.
19
The website of an out-of-state telehealth provider registered under s. 456.47, F.S., must
prominently display a hyperlink to the DOH’s website, and the DOH’s website must publish a
list of all out-of-state registrants and include the following information for each:
Name;
Health care occupation;
Health care training and education, including completion dates and any certificates or
degrees obtained;
Out-of-state health care licenses, including license numbers;
Florida telehealth provider registration number;
Specialty, if any;
Board certification, if any;
Five-years of disciplinary history, including sanctions imposed and board actions;
Medical malpractice insurance provider and policy limits, including whether the policy
covers claims that arise in Florida; and
The name and address of the registered agent designated for service of process in this state.
20
A health care professional may not register under s. 456.47, F.S., if his or her license to provide
health care services is subject to a pending disciplinary investigation or action; or has been
revoked in any state or jurisdiction. A health care professional registered under this subsection
must notify the appropriate board, or the DOH if there is no board, of any restrictions placed on
15
TELEHEALTH.HHS.GOV , “Asynchronous direct-to-consumer telehealth,” available at
https://telehealth.hhs.gov/providers/direct-to-consumer/asynchronous-direct-to-consumer-telehealth/ (last visited Jan. 10,
2024).
16
Under s. 456.001(1), F.S., the term “board” is defined as any board, commission, or other statutorily created entity, to the
extent such entity is authorized to exercise regulatory or rulemaking functions within DOH or, in some cases, within DOH’s
Division of Medical Quality Assurance (MQA).
17
Section 456.47(4), F.S.
18
Id.
19
Section 456.47(3), F.S.
20
Section 456.47(4)(h), F.S. BILL: SB 302 Page 6
his or her license to practice, or any disciplinary action taken or pending against him or her, in
any state or jurisdiction. The notification must be provided within five business days after the
restriction is placed or disciplinary action is initiated or taken.
21
The applicable board, or the DOH if there is no board, may take disciplinary action against an
out-of-state telehealth provider registered under s. 456.47, F.S., if the registrant:
Fails to notify the applicable board, or the DOH if there is no board, of any adverse actions
taken against his or her license;
Has restrictions placed on, or disciplinary action taken against, his or her license in any state
or jurisdiction;
Violates any of the requirements of s. 456.47, F.S.; or
Commits any act that constitutes grounds for disciplinary action under s. 456.072, F.S, or the
applicable practice act for similarly licenses Florida providers.
22
Venue for civil or administrative actions initiated by the DOH, a board, or a patient who receives
telehealth services from an out-of-state telehealth provider may be located in the patient’s county
of residence or in Leon County.
23
A health care professional who is not licensed to provide
health care services in Florida, but who holds an active license to provide health care services in
another state or jurisdiction, and who provides such services using telehealth to a patient located
in Florida, is not subject to the registration requirement under s. 456.47, F.S., if the services are
provided:
In response to an emergency medical condition; or
In consultation with a health care professional licensed Florida who has ultimate authority
over the diagnosis and care of the patient.
24
III. Effect of Proposed Changes:
Section 1 defines “digital scanning” for dentistry as the use of digital technology to create a
computer-generated replica of the hard and soft tissue of the oral cavity using enhanced digital
photography, lasers, or other optical scanning devices.
Section 2 amends s. 466.016, F.S., to require that every dentist must provide each of his or her
patients with the dentist’s name, contact telephone number, after-hours contact information for
emergencies, and, upon the patient’s request, license information. Any individual, partnership,
corporation, or other entity that provides dental services through telehealth must also provide its
patients 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
provides dental services to the patient.
Section 3 requires that for any dental patient treated through telehealth there must be a dentist of
record as described in s. 466.018, F.S., who remains primarily responsible for all dental
treatment on the patient regardless of whether the treatment is rendered by the dentist of record,
21
Section 456.47 (4)(d), F.S.
22
Section 456.47(4)(i), F.S.
23
Section 456.47(5), F.S.
24
Section 456.47(6), F.S. BILL: SB 302 Page 7
another dentist, a dental hygienist, or dental assistant, in conjunction, or at the direction of, or
under the supervision of, the dentist of record. A dentist of record for a telehealth patient is
subject to all of the requirements S. 466.018, F.S., applicable to dentists of record.
The bill requires that any individual, partnership, corporation, or other entity that provides dental
services through telehealth must also make available to the patient, before services are rendered,
the name, the telephone number, practice address, and state license number for the dentist of
record and any other dentist who will be providing dental services to the patient, and at any time
requested by a patient.
The bill clarifies that s. 466.018, F.S., is not to be construed to assign any responsibility to a
dentist of record for treatment rendered pursuant to a proper referral to another dentist who is not
in the same practice with the dentist of record or to prohibit a patient from voluntarily selecting a
new dentist without permission of the dentist of record.
Section 4 defines advertisement for s. 466.019, F.S., as a representation disseminated in any
manner or by any means to solicit patients and includes, but is not limited to, business cards,
circulars, pamphlets, newspapers, websites, and social media.
The bill amends s. 466.019, F.S., to require that an advertisement for dental services provided
through 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” for each of the
following dental services, if advertised:
The taking of an impression or the digital scanning 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.
Section 5 amends s. 466.028, F.S., to create additional offenses that constitute grounds for the
denial of a dental license or disciplinary action against a dentist:
Failure by the dentist of record, before the initial diagnosis and correction of a malposition of
human teeth or initial use of an orthodontic appliance, to perform an in-person examination
of the patient or obtain records from an in-person examination within the last six months and
to perform a review of the patient’s most recent diagnostic digital or conventional
radiographs or other equivalent bone imaging suitable for orthodontia. However, this
provision does not apply to:
o Providing emergent care;
o Providing care in connection with a public health program; or
o In making an initial diagnosis of a malposition of teeth and a determination of the need
for an orthodontic appliance. However, such an initial diagnosis and determination must
be confirmed through an in-person examination and the review of the patient’s most
recent diagnostic digital or conventional radiographs before the patient begins using the
orthodontic appliance. BILL: SB 302 Page 8
For dental services provided in-person or through telehealth by an individual, a partnership, a
corporation, or any other entity, failing 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 to the
patient; and
For dental services provided through telehealth by an individual, a partnership, a corporation,
or any other entity, failing to designate a dentist of record and make available, before the
rendering of such services and upon the patient’s request, the name, telephone number,
practice address, and state license number for the dentist of record and any other dentist who
will be involved in the provision of dental services to the patient through telehealth.
According to the DOH, a direct-to-consumer teeth aligner business model currently exists for
consumers. Dental impressions are being taken by the consumer using a dental impression kit
mailed by the aligner company, or the consumer visits a location for a digital scan by a
technician. The impression or image is then reviewed by a dentist to create custom aligners,
which are shipped back to the consumer for use. This business model does not include an in-
person examination by a licensed dentist or direct supervision by a licensed dentist when digital
scanning is performed.
25
The bill takes effect July 1, 2024.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
25
Florida Department of Health, 2023 Agency Legislative Bill Analysis, Senate Bill 356, Jan. 25, 2023 (on file with the
Senate Committee on Health Policy). BILL: SB 302 Page 9
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
According to the Department of Health (DOH), the provisions of the bill may result in an
increase in revenues for individual dentistry practices due to the creation of a standard
that would require a dentist of record to perform an in-person examination of a patient or
obtain records from an in-person examination within the last six months before the initial
diagnosis and correction of a malposition of human teeth or initial use of an orthodontic
appliance.
26
C. Government Sector Impact:
The bill has an indeterminate, yet significant negative fiscal impact on the DOH,
however, current resources are adequate to absorb these costs. According to the DOH, the
department will experience an increase in workload associated with complaints and
investigations under the bill. The fiscal impact is indeterminate; therefore, the fiscal
impact cannot be calculated at this time.
27
The DOH has also indicated it will incur nonrecurring costs for rulemaking, which
current budget authority is adequate to absorb.
The department will also experience a nonrecurring increase in workload and costs
associated with updating the Licensing and Enforcement Information Database System,
Online Service Portal, Artificial Intelligence Virtual Customer Contact Agent,
Continuing Education Tracking System, License Verification Search Site, and Board of
Dentistry (BOD) website. Resources and budget authority are adequate to absorb.
28
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 466.003, 466.016,
466.018, 466.019, and 466.028.
26
Florida Department of Health, 2023 Agency Legislative Bill Analysis, Senate Bill 356, Jan. 25, 2023 (on file with the
Senate Committee on Health Policy).
27
Id.
28
Id. BILL: SB 302 Page 10
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.