23 LC 52 0290S
H. B. 441 (SUB)
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The House Committee on Health offers the following substitute to HB 441:
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 11 of Title 43 of the Official Code of Georgia Annotated, relating to1
dentists, dental hygienists, and dental assistants, so as to authorize and regulate teledentistry2
in this state by licensed dentists pursuant to permits issued by the Georgia Board of3
Dentistry; to provide for definitions; to provide for the issuance and renewal of permits for4
teledentistry; to provide for an exemption; to provide for conditions for such permit; to5
provide for authorized practices; to provide for a referred dentist; to provide for ownership6
of documents; to provide for a limited number of dental auxiliaries to perform teledentistry;7
to require health insurers to cover dental care provided through teledentistry; to prohibit8
health insurers from requiring covered persons to obtain dental care through teledentistry;9
to provide for enforcement by the Commissioner of Insurance regarding insurance coverage10
of teledentistry; to provide for the Georgia Board of Dentistry to promulgate rules and11
regulations; to provide for dental assistants to perform coronal polishing under direct12
supervision; to provide for related matters; to provide an effective date; to repeal conflicting13
laws; and for other purposes.14
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:15 23 LC 52 0290S
H. B. 441 (SUB)
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SECTION 1.16
Chapter 11 of Title 43 of the Official Code of Georgia Annotated, relating to dentists, dental17
hygienists, and dental assistants, is amended in Article 2, relating to licenses for the practice18
of dentistry, by adding a new Code section to read as follows:19
"43-11-54.20
(a) As used in this Code section, the term:21
(1) 'Authorizing dentist' means a licensed dentist in good standing and practicing in the22
State of Georgia who holds a current, valid teledentistry permit issued by the board23
pursuant to this Code section.24
(2) 'Care management organization' shall have the same meaning as in Code25
Section 33-24-59.24.26
(3) 'Dental auxiliary' means a licensed dental hygienist or an expanded duties dental27
assistant.28
(4) 'Dental hygienist' means a licensed dental hygienist in good standing who meets the29
requirements to perform the specific dental hygiene functions permitted under general30
supervision under Code Section 43-11-74.31
(5) 'Digital scan' means a computer generated replica of the hard and soft tissues of the32
oral cavity created with digital technology and enhanced digital photography.33
(6) 'Direct supervision' shall have the same meaning as in Code Section 43-11-74.34
(7) 'Expanded duties dental assistant' means a dental assistant who has met the additional35
education and training requirements established by the board pursuant to subsection (b)36
of Code Section 43-11-80 to perform such other acts, practices, services, or procedures.37
(8) 'General supervision' shall have the same meaning as in Code Section 43-11-74.38
(9) 'Health insurance plan' shall have the same meaning as in Code Section 33-24-59.24.39
(10) 'Health insurer' shall have the same meaning as in Code Section 33-24-59.24.40 23 LC 52 0290S
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(11) 'Referred dentist' means a licensed dentist practicing in Georgia who has a written41
agreement with an authorizing dentist to provide in-person dental treatment to patients42
receiving dental care through a teledentistry interaction under this Code section.43
(12) 'Store and forward technologies' means technologies that allow for the electronic44
transmission of dental and health information, including images, photographs,45
documents, and health histories, through a secure communication system.46
(13) 'Synchronous, real-time communication' means a live, two-way interaction between47
an authorizing dentist and a patient or applicable dental auxiliary permitted under this48
Code section using audiovisual telecommunications technology but shall not constitute49
direct supervision for the purposes of Code Section 43-11-74 and the practice of dentistry50
in this state.51
(14) 'Teledentistry' means the delivery of dental care through the use of synchronous,52
real-time communication in conjunction with and supported by store and forward53
technologies under the general supervision of the authorizing dentist when dental care is54
provided to a patient physically located at a site in this state that is different from the site55
where the authorizing dentist is physically located. A teledentistry interaction shall not56
constitute or be considered the equivalent of an in-person, clinical examination by a57
licensed dentist.58
(b)(1) No licensed dentist in this state shall provide dental care through teledentistry59
unless such dentist has been issued a permit by the board under the conditions specified60
in this Code section. Such permit shall be subject to biennial renewal at the time the61
dentist is required to renew his or her license to practice dentistry.62
(2) Notwithstanding the provisions of paragraph (1) of this subsection, a teledentistry63
permit shall not be required for a licensed dentist who only provides dental care to64
patients in a private dental office and does not authorize any dental auxiliaries to perform65
dental care outside of such private dental office when such dentist receives a digital66
photograph or audio or video communication from the cellphone of a patient of record67 23 LC 52 0290S
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for the purpose of evaluating a dental emergency or providing palliative care until the68
patient can be treated by such dentist. Such dentist shall not charge the patient for such69
emergency evaluation or palliative care.70
(c) A licensed dentist who wishes to provide dental care through teledentistry pursuant to71
this Code section shall apply to the board for a teledentistry permit. No permit shall be72
issued or renewed under this Code section unless the licensed dentist:73
(1) Submits an application under oath on a form prescribed by the board;74
(2) Pays the applicable initial issuance or renewal fee as established by the board;75
(3) Provides written documentation evidencing that such licensed dentist has established76
a referral relationship with a referred dentist who practices dentistry and treats patients77
in a physical and operational dental office located in this state within 50 miles of the78
setting where the teledentistry interaction will occur; and79
(4) Provides any other pertinent information as prescribed by the board.80
(d) Subject to the conditions specified in subsection (e) of this Code section, an81
authorizing dentist possessing a teledentistry permit under this Code section shall only be82
authorized to:83
(1) Authorize a licensed dental hygienist to perform the specific dental hygiene functions84
permitted under general supervision in accordance with the requirements of Code85
Section 43-11-74, except as otherwise provided in paragraph (1) of subsection (e) of this86
Code section;87
(2) Prescribe a medication that is not a controlled substance for a patient receiving dental88
care through a teledentistry interaction, unless a teledentistry permit is not required89
pursuant to paragraph (2) of subsection (b) of this Code section;90
(3) Authorize the performance of digital scans; provided, however, that only a licensed91
dentist, licensed dental hygienist, or expanded duties dental assistant possessing the92
requisite education and training prescribed by the board shall be permitted to perform93
digital scans for use in teledentistry; and94 23 LC 52 0290S
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(4) Authorize the use of store and forward technologies to transmit patient records,95
images, digital scans, X-rays, and other relevant health information between the96
authorizing dentist and dental auxiliary for the purposes of evaluating a patient's oral97
health condition and authorizing the performance of dental care permitted under this98
Code section. The authorizing dentist shall be the custodian of all patient records for the99
purposes of this Code section unless the patient is treated by a referred dentist. In such100
instance, the referred dentist shall be the custodian of the patient's records associated with101
the dental care the referred dentist provides to the patient, and such referred dentist shall102
furnish copies of these records to the authorizing dentist.103
(e) An authorizing dentist shall be subject to the following conditions when providing104
dental care through teledentistry as authorized in subsection (d) of this Code section:105
(1) Teledentistry services shall be consistent with how dental treatment is provided in106
person and shall adhere to the standards of appropriate patient care required in other107
dental care settings, including, but not limited to, appropriate patient examination, the108
taking and review of X-rays, and review of a patient's medical and dental history;109
provided, however, that X-rays taken for the purpose of a teledentistry interaction under110
this Code section shall only be taken by a licensed dentist or by a licensed dental111
hygienist practicing under direct supervision of the authorizing dentist or during a112
synchronous, real-time communication involving the authorizing dentist, dental hygienist,113
and patient;114
(2)(A) As part of the initial consultation with all new patients, the authorizing dentist115
shall establish a bona fide dentist-patient relationship by reviewing the patient's medical116
and dental history and verifying the patient's identity and physical location to ensure the117
patient is physically located in this state when dental care is provided and shall obtain118
the requisite consent from a parent or guardian if the patient is a minor.119
(B) Prior to practicing and authorizing teledentistry pursuant to this Code section in120
board approved dental facilities and offsite locations of the Department of Public121 23 LC 52 0290S
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Health, county boards of health, or the Department of Corrections; Title I schools under122
the federal Elementary and Secondary Education Act; schools in which at least123
65 percent of the student population is eligible for free or reduced price lunch under124
federal guidelines; Head Start programs; Georgia's Pre-K Program; hospitals; nursing125
homes; long-term care facilities; rural health clinics; federally qualified health centers;126
health facilities operated by federal, state, county, or local governments; hospices;127
family violence shelters as defined in Code Section 19-13-20; and free health clinics128
as defined in Code Section 51-1-29.4, the authorizing dentist shall perform the initial129
consultation with the patient through an in-person, clinical examination of the patient130
or through synchronous, real-time communication or asynchronous communication131
involving the authorizing dentist, the applicable dental auxiliary permitted under this132
Code section, and the patient.133
(C) Prior to practicing and authorizing teledentistry in all other settings in this state134
under this Code section, the authorizing dentist shall perform the initial consultation135
with the patient in person, which shall include a clinical examination of the patient, and136
such in-person clinical examination shall be performed at a minimum of every 12137
months by the authorizing dentist;138
(3) The authorizing dentist shall prepare a written authorization, which shall be given to139
the patient and included in the patient's record, providing the name and license number140
of the authorizing dentist and the name and license number of any dental auxiliaries141
treating the patient during the teledentistry interaction, as well as any other information142
the authorizing dentist or board deem appropriate;143
(4) Prior to each teledentistry interaction, informed consent shall be obtained from the144
patient, or from the parent or guardian if the patient is a minor, explaining the alternatives145
to and the capabilities and limitations of teledentistry, which shall include a written146
statement advising that a teledentistry interaction is not equivalent to an in-person,147
clinical examination, and that the authorizing dentist will not be physically present during148 23 LC 52 0290S
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the delivery of dental care. Such informed consent shall also be documented and149
included in the patient's record;150
(5) The authorizing dentist shall provide dental services through teledentistry only if151
such dental services are appropriate for the patient, as determined by such authorizing152
dentist;153
(6)(A) The authorizing dentist shall provide the name, license number, office mailing154
address, and office phone number of the referred dentist to the patient after each155
teledentistry interaction.156
(B) The referred dentist shall accept a referral to treat all dental emergencies and157
provide all necessary dental care, as determined by and in consultation with the158
authorizing dentist.159
(C) The authorizing dentist shall submit updated documentation to the board regarding160
any changes to the referral relationship within 30 days of any such changes.161
(D) Documentation of a referral relationship shall not be required for the issuance of162
a teledentistry permit if the authorizing dentist will also be providing in-person dental163
care;164
(7)(A) An authorizing dentist may only authorize up to four licensed dental hygienists165
and up to four expanded duties dental assistants to perform the functions permitted in166
subsection (d) of this Code section at any one time.167
(B) Any licensed dental hygienist performing the functions permitted in subsection (d)168
of this Code section via teledentistry shall have at least two years of experience in the169
practice of dental hygiene, shall be in compliance with continuing education170
requirements pursuant to Code Section 43-11-73.1 and cardiopulmonary resuscitation171
certification requirements contained in Code Section 43-11-73, and shall be licensed172
in good standing.173
(C) Licensed dental hygienists practicing under general supervision via teledentistry174
pursuant to this Code section shall maintain professional liability insurance in175 23 LC 52 0290S
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accordance with board rules and regulations; provided, however, that this subparagraph176
shall not apply to an entity covered under sovereign immunity;177
(8) No authorizing dentist or dental auxiliary shall attempt to waive liability for178
teledentistry services in advance of delivering such services, and no authorizing dentist179
or dental auxiliary shall attempt to prevent a patient from filing any complaint with any180
governmental agency or authority relating to the provision of dental care through181
teledentistry; and182
(9) The authorizing dentist shall ensure that the use of teledentistry complies with the183
privacy and security requirements of the federal Health Insurance Portability and184
Accountability Act of 1996, as well as those of Chapter 33 of Title 31.185
(f) A permit issued under this Code section may be revoked or not renewed if the board186
determines that the dentist holding such permit is not in compliance with any requirement187
of this Code section. The board shall provide notice and opportunity for hearing under188
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act,' in any case in which189
it revokes or refuses to renew a permit, provided that summary action regarding such190
permit shall be authorized under Code Section 50-13-18.191
(g) Nothing in this Code section shall be construed to:192
(1) Require a licensed dentist in this state to practice teledentistry;193
(2) Require a licensed dentist to authorize a licensed dental hygienist or expanded duties194
dental assistant to perform the functions permitted in this Code section via teledentistry;195
(3) Require a school or facility receiving dental hygiene services provided pursuant to196
subsection (h) or (i) of Code Section 43-11-74 to purchase any equipment to provide197
dental care through teledentistry; or198
(4) Expand the scope of practice for dental hygienists or establish independent dental199
hygiene practice.200
(h)(1) Any health insurance plan issued, amended, or renewed on or after January 1,201
2024, between a health insurer, contracted vendor thereof, or a care management202 23 LC 52 0290S
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organization and a healthcare provider for the provision of healthcare services to a plan203
enrollee shall provide coverage for the cost of dental care provided through teledentistry204
as directed through regulations promulgated by the Department of Insurance.205
(2) A health insurer, contracted vendor thereof, or care management organization shall206
not exclude a service appropriately provided through teledentistry from coverage solely207
because the service is provided through teledentistry and is not provided through208
in-person consultation or contact between an authorizing dentist and a patient.209
(3) No health insurer, contracted vendor thereof, or care management organization shall210
impose any annual or lifetime dollar maximum on coverage for teledentistry services,211
other than an annual or lifetime dollar maximum that applies in the aggregate to all items212
and services covered under the patient's policy, or impose upon any patient receiving213
benefits pursuant to this Code section any copayment, coinsurance, or deductible214
amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation215
or maximum for benefits or services, that is not equally imposed upon all terms and216
services covered under the patient's health insurance policy.217
(4) No health insurer, contracted vendor thereof, or care management organization shall218
require its insureds to receive dental care through teledentistry in lieu of an in-person,219
clinical examination.220
(5) The Commissioner of Insurance shall have all powers of enforcement and sanction221
with respect to violations of this subsection by any health insurer, contracted vendor222
thereof, or care management organization as provided in Title 33.223
(i) The board shall promulgate rules and regulations that are reasonably necessary to224
implement the provisions of this Code section."225 23 LC 52 0290S
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SECTION 2.226
Said chapter is further amended in Code Section 43-11-74, relating to required direct227
supervision, scope of duties, and exceptions to required supervision for dental screenings,228
by revising subsection (n) as follows:229
"(n) Dental assistants may use rubber cup prophy perform coronal polishing on a patient230
with primary dentition under the direct supervision of a licensed dentist in accordance with231
any guidelines or rules established by the board. Dental assistants shall meet any232
education, training, or other requirements as established by the board."233
SECTION 3.234
This Act shall become effective on January 1, 2024.235
SECTION 4.236
All laws and parts of laws in conflict with this Act are repealed.237