24 LC 52 0482S
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
by licensed dentists in this state; to provide for definitions; to provide for exemptions and3
conditions; to provide for authorized practices; to provide for a referred dentist; to provide4
for ownership of documents; to provide for a limited number of dental hygienists and5
expanded duties dental assistants to perform teledentistry; to require health insurers to cover6
dental care provided through teledentistry; to prohibit health insurers from requiring covered7
persons to obtain dental care through teledentistry; to provide for enforcement by the8
Commissioner of Insurance regarding insurance coverage of teledentistry; to provide for the9
Georgia Board of Dentistry to promulgate rules and regulations; to provide for related10
matters; to provide an effective date; to repeal conflicting laws; and for other purposes.11
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:12
SECTION 1.13
Chapter 11 of Title 43 of the Official Code of Georgia Annotated, relating to dentists, dental14
hygienists, and dental assistants, is amended in Article 2, relating to licenses for the practice15
of dentistry, by adding a new Code section to read as follows:16
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"43-11-54.17
(a) As used in this Code section, the term:18
(1) 'Authorizing dentist' means a licensed dentist in good standing and practicing in the19
State of Georgia.20
(2) 'Care management organization' shall have the same meaning as in Code21
Section 33-24-59.24.22
(3) 'Dental hygienist' means a licensed dental hygienist in good standing who meets the23
requirements to perform the specific dental hygiene functions permitted under general24
supervision under Code Section 43-11-74.25
(4) 'Digital scan' means a computer generated replica of the hard and soft tissues of the26
oral cavity created with digital technology and enhanced digital photography.27
(5) 'Direct supervision' shall have the same meaning as in Code Section 43-11-74.28
(6) 'Expanded duties dental assistant' means a dental assistant who has met the additional29
education and training requirements established by the board pursuant to subsection (b)30
of Code Section 43-11-80 to perform such other acts, practices, services, or procedures.31
(7) 'General supervision' shall have the same meaning as in Code Section 43-11-74.32
(8) 'Health insurance plan' shall have the same meaning as in Code Section 33-24-59.24.33
(9) 'Health insurer' shall have the same meaning as in Code Section 33-24-59.24.34
(10) 'Referred dentist' means a licensed dentist practicing in this state who has a written35
agreement with an authorizing dentist to provide in-person dental treatment to patients36
receiving dental care through a teledentistry interaction under this Code section.37
(11) 'Store and forward technologies' means technologies that allow for the electronic38
transmission of dental and health information, including images, photographs,39
documents, and health histories, through a secure communication system.40
(12) 'Synchronous, real-time communication' means a live, two-way interaction between41
the authorizing dentist and a dental hygienist, expanded duties dental assistant, or patient42
permitted under this Code section using audiovisual telecommunications technology but43
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shall not constitute direct supervision for the purposes of Code Section 43-11-74 and the44
practice of dentistry in this state.45
(13) 'Teledentistry' means the delivery of dental care through the use of synchronous,46
real-time communication in conjunction with and supported by store and forward47
technologies under the general supervision of the authorizing dentist when dental care is48
provided to a patient physically located at a site in this state that is different from the site49
where the authorizing dentist is physically located. Teledentistry shall not include when50
a licensed dentist providing dental care to patients in a private dental office receives a51
digital photograph or audio or video communication from the cellphone of a patient of52
record for the purpose of evaluating a dental emergency or providing palliative care until53
the patient can be treated by such dentist. Such dentist shall not charge the patient for54
such emergency evaluation or palliative care. A teledentistry interaction shall not55
constitute or be considered the equivalent of an in-person, clinical examination by a56
licensed dentist.57
(b) No licensed dentist in this state shall provide dental care through teledentistry except58
under the conditions specified in this Code section.59
(c) A licensed dentist who wishes to provide dental care through teledentistry pursuant to60
this Code section shall so notify the board; provide written documentation evidencing that61
such dentist has established a referral relationship with a referred dentist who practices62
dentistry and treats patients in a physical and operational dental office located in this state63
within 50 miles of the setting where the teledentistry interaction will occur, provided that64
if no such office is available, then the closest dental office within the state; and provide any65
other pertinent information as prescribed by the board.66
(d) Subject to the conditions specified in subsection (e) of this Code section, an67
authorizing dentist shall only be authorized to:68
(1) Authorize a dental hygienist to perform the specific dental hygiene functions69
permitted under general supervision in accordance with the requirements of Code70
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Section 43-11-74, except as otherwise provided in paragraph (1) of subsection (e) of this71
Code section;72
(2) Prescribe a medication that is not a controlled substance for a patient receiving dental73
care through a teledentistry interaction;74
(3) Authorize the performance of digital scans by a dentist or dental hygienist; and75
(4) Authorize the use of store and forward technologies to transmit patient records,76
images, digital scans, X-rays, and other relevant health information between the77
authorizing dentist and a dental hygienist or expanded duties dental assistant for the78
purposes of evaluating a patient's oral health condition and authorizing the performance79
of dental care permitted under this Code section. The authorizing dentist shall be the80
custodian of all patient records for the purposes of this Code section unless the patient is81
treated by a referred dentist. In such instance, the referred dentist shall be the custodian82
of the patient's records associated with the dental care the referred dentist provides to the83
patient, and such referred dentist shall furnish copies of these records to the authorizing84
dentist.85
(e) An authorizing dentist shall be subject to the following conditions when providing86
dental care through teledentistry as authorized in subsection (d) of this Code section:87
(1) Teledentistry services shall be consistent with how dental treatment is provided in88
person and shall adhere to the standards of appropriate patient care required in other89
dental care settings, including, but not limited to, appropriate patient examination, the90
taking and review of X-rays, and review of a patient's medical and dental history;91
(2)(A) As part of the initial consultation with all new patients, the authorizing dentist92
shall establish a bona fide dentist-patient relationship by reviewing the patient's medical93
and dental history and verifying the patient's identity and physical location to ensure the94
patient is physically located in this state when dental care is provided and shall obtain95
the requisite consent from a parent or guardian if the patient is a minor.96
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(B) Prior to practicing and authorizing teledentistry pursuant to this Code section in97
board approved dental facilities and offsite locations of the Department of Public98
Health, county boards of health, or the Department of Corrections; Title I schools under99
the federal Elementary and Secondary Education Act; schools in which at least100
65 percent of the student population is eligible for free or reduced price lunch under101
federal guidelines; Head Start programs; Georgia's Pre-K Program; hospitals; nursing102
homes; long-term care facilities; rural health clinics; federally qualified health centers;103
health facilities operated by federal, state, county, or local governments; hospices;104
family violence shelters as defined in Code Section 19-13-20; and free health clinics105
as defined in Code Section 51-1-29.4, the authorizing dentist shall perform the initial106
consultation with the patient through an in-person, clinical examination of the patient107
or through synchronous, real-time communication or asynchronous communication108
involving the authorizing dentist, dental hygienist, expanded duties dental assistant, and109
patient as permitted under this Code section.110
(C) Prior to practicing and authorizing teledentistry in all other settings in this state111
under this Code section, the authorizing dentist shall perform the initial consultation112
with the patient in person, which shall include a clinical examination of the patient, and113
such in-person clinical examination shall be performed at a minimum of every 12114
months by the authorizing dentist;115
(3) The authorizing dentist shall prepare a written authorization, which shall be given to116
the patient and included in the patient's record, providing the name and license number117
of the authorizing dentist and the name and license number of licensed dental hygienist118
or expanded duties dental assistant treating the patient during the teledentistry interaction,119
as well as any other information the authorizing dentist or board deems appropriate;120
(4) Prior to each teledentistry interaction, informed consent shall be obtained from the121
patient, or from the parent or guardian if the patient is a minor, explaining the alternatives122
to and the capabilities and limitations of teledentistry, which shall include a written123
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statement advising that a teledentistry interaction is not equivalent to an in-person,124
clinical examination, and that the authorizing dentist will not be physically present during125
the delivery of dental care. Such informed consent shall also be documented and126
included in the patient's record;127
(5) The authorizing dentist shall provide dental services through teledentistry only if128
such dental services are appropriate for the patient, as determined by such authorizing129
dentist;130
(6)(A) The authorizing dentist shall provide the name, license number, office mailing131
address, and office phone number of the referred dentist to the patient after each132
teledentistry interaction.133
(B) The referred dentist shall accept a referral to treat all dental emergencies and134
provide all necessary dental care, as determined by and in consultation with the135
authorizing dentist.136
(C) The authorizing dentist shall submit updated documentation to the board regarding137
any changes to the referral relationship within 30 days of any such changes; provided,138
however, that documentation of a referral relationship shall not be required if the139
authorizing dentist will also be providing in-person dental care;140
(7)(A) An authorizing dentist may only authorize up to four licensed dental hygienists141
and up to four expanded duties dental assistants to perform the functions permitted in142
subsection (d) of this Code section at any one time.143
(B) Any dental hygienist performing the functions permitted in subsection (d) of this144
Code section via teledentistry shall have at least two years of experience in the practice145
of dental hygiene, shall be in compliance with continuing education requirements146
pursuant to Code Section 43-11-73.1 and cardiopulmonary resuscitation certification147
requirements contained in Code Section 43-11-73, and shall be licensed in good148
standing.149
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(C) Any dental hygienist practicing under general supervision via teledentistry150
pursuant to this Code section shall maintain professional liability insurance in151
accordance with board rules and regulations; provided, however, that this subparagraph152
shall not apply to an entity covered under sovereign immunity;153
(8) No authorizing dentist, dental hygienist, or expanded duties dental assistant shall154
attempt to waive liability for teledentistry services in advance of delivering such services,155
and no authorizing dentist, dental hygienist, or expanded duties dental assistant shall156
attempt to prevent a patient from filing any complaint with any governmental agency or157
authority relating to the provision of dental care through teledentistry; and158
(9) The authorizing dentist shall ensure that the use of teledentistry complies with the159
privacy and security requirements of the federal Health Insurance Portability and160
Accountability Act of 1996, as well as those of Chapter 33 of Title 31.161
(f) Nothing in this Code section shall be construed to:162
(1) Require a licensed dentist in this state to practice teledentistry;163
(2) Require a licensed dentist to authorize a dental hygienist or expanded duties dental164
assistant to perform the functions permitted in this Code section via teledentistry;165
(3) Require a school or facility receiving dental hygiene services provided pursuant to166
subsection (h) or (i) of Code Section 43-11-74 to purchase any equipment to provide167
dental care through teledentistry; or168
(4) Expand the scope of practice for dental hygienists or establish independent dental169
hygiene practice.170
(g)(1) Any health insurance plan issued, amended, or renewed on or after January 1,171
2024, between a health insurer, contracted vendor thereof, or a care management172
organization and a healthcare provider for the provision of healthcare services to a plan173
enrollee shall provide coverage for the cost of dental care provided through teledentistry174
as directed through regulations promulgated by the Department of Insurance.175
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(2) A health insurer, contracted vendor thereof, or care management organization shall176
not:177
(A) Exclude a service appropriately provided through teledentistry from coverage178
solely because the service is provided through teledentistry and is not provided through179
in-person consultation or contact between an authorizing dentist and a patient;180
(B) Impose any annual or lifetime dollar maximum on coverage for teledentistry181
services, other than an annual or lifetime dollar maximum that applies in the aggregate182
to all items and services covered under the patient's policy, or impose upon any patient183
receiving benefits pursuant to this Code section any copayment, coinsurance, or184
deductible amounts, or any policy year, calendar year, lifetime, or other durational185
benefit limitation or maximum for benefits or services, that is not equally imposed upon186
all terms and services covered under the patient's health insurance policy; or187
(C) Require its insureds to receive dental care through teledentistry in lieu of an188
in-person, clinical examination.189
(3) The Commissioner of Insurance shall have all powers of enforcement and sanction190
with respect to violations of this subsection by any health insurer, contracted vendor191
thereof, or care management organization as provided in Title 33.192
(h) The board shall promulgate rules and regulations that are reasonably necessary to193
implement the provisions of this Code section."194
SECTION 2.195
This Act shall become effective on January 1, 2025.196
SECTION 3.197
All laws and parts of laws in conflict with this Act are repealed.198
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