| 19 | 6 | | dentists, dental hygienists, and dental assistants, so as to authorize and regulate teledentistry2 |
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| 20 | 7 | | by licensed dentists in this state; to provide for definitions; to provide for exemptions and3 |
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| 21 | 8 | | conditions; to provide for authorized practices; to provide for a referred dentist; to provide4 |
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| 22 | 9 | | for ownership of documents; to provide for a limited number of dental hygienists to perform5 |
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| 23 | 10 | | teledentistry; to require health insurers to cover dental care provided through teledentistry;6 |
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| 24 | 11 | | to prohibit health insurers from requiring covered persons to obtain dental care through7 |
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| 25 | 12 | | teledentistry; to provide for enforcement by the Commissioner of Insurance regarding8 |
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| 26 | 13 | | insurance coverage of teledentistry; to provide for the Georgia Board of Dentistry to9 |
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| 27 | 14 | | promulgate rules and regulations; to provide for related matters; to provide an effective date;10 |
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| 28 | 15 | | to repeal conflicting laws; and for other purposes.11 |
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| 29 | 16 | | BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:12 |
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| 30 | 17 | | SECTION 1.13 |
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| 31 | 18 | | Chapter 11 of Title 43 of the Official Code of Georgia Annotated, relating to dentists, dental14 |
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| 32 | 19 | | hygienists, and dental assistants, is amended in Article 2, relating to licenses for the practice15 |
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| 33 | 20 | | of dentistry, by adding a new Code section to read as follows:16 |
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| 36 | 22 | | "43-11-54.17 |
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| 37 | 23 | | (a) As used in this Code section, the term:18 |
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| 38 | 24 | | (1) 'Authorizing dentist' means a licensed dentist in good standing and practicing in the19 |
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| 39 | 25 | | State of Georgia.20 |
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| 40 | 26 | | (2) 'Care management organization' shall have the same meaning as in Code21 |
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| 41 | 27 | | Section 33-24-59.24.22 |
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| 42 | 28 | | (3) 'Dental hygienist' means a licensed dental hygienist in good standing who meets the23 |
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| 43 | 29 | | requirements to perform the specific dental hygiene functions permitted under general24 |
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| 44 | 30 | | supervision under Code Section 43-11-74.25 |
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| 45 | 31 | | (4) 'Digital scan' means a computer generated replica of the hard and soft tissues of the26 |
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| 46 | 32 | | oral cavity created with digital technology and enhanced digital photography.27 |
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| 47 | 33 | | (5) 'Direct supervision' shall have the same meaning as in Code Section 43-11-74.28 |
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| 48 | 34 | | (6) 'General supervision' shall have the same meaning as in Code Section 43-11-74.29 |
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| 49 | 35 | | (7) 'Health insurance plan' shall have the same meaning as in Code Section 33-24-59.24.30 |
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| 50 | 36 | | (8) 'Health insurer' shall have the same meaning as in Code Section 33-24-59.24.31 |
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| 51 | 37 | | (9) 'Referred dentist' means a licensed dentist practicing in this state who has a written32 |
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| 52 | 38 | | agreement with an authorizing dentist to provide in-person dental treatment to patients33 |
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| 53 | 39 | | receiving dental care through a teledentistry interaction under this Code section.34 |
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| 54 | 40 | | (10) 'Store and forward technologies' means technologies that allow for the electronic35 |
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| 55 | 41 | | transmission of dental and health information, including images, photographs,36 |
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| 56 | 42 | | documents, and health histories, through a secure communication system.37 |
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| 57 | 43 | | (11) 'Synchronous, real-time communication' means a live, two-way interaction between38 |
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| 58 | 44 | | the authorizing dentist and a dental hygienist or patient permitted under this Code section39 |
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| 59 | 45 | | using audiovisual telecommunications technology but shall not constitute direct40 |
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| 60 | 46 | | supervision for the purposes of Code Section 43-11-74 and the practice of dentistry in this41 |
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| 61 | 47 | | state.42 |
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| 64 | 49 | | (12) 'Teledentistry' means the delivery of dental care through the use of synchronous,43 |
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| 65 | 50 | | real-time communication in conjunction with and supported by store and forward44 |
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| 66 | 51 | | technologies under the general supervision of the authorizing dentist when dental care is45 |
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| 67 | 52 | | provided to a patient physically located at a site in this state that is different from the site46 |
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| 68 | 53 | | where the authorizing dentist is physically located. Teledentistry shall not include when47 |
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| 69 | 54 | | a licensed dentist providing dental care to patients in a private dental office receives a48 |
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| 70 | 55 | | digital photograph or audio or video communication from the cellphone of a patient of49 |
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| 71 | 56 | | record for the purpose of evaluating a dental emergency or providing palliative care until50 |
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| 72 | 57 | | the patient can be treated by such dentist. Such dentist shall not charge the patient for51 |
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| 73 | 58 | | such emergency evaluation or palliative care. A teledentistry interaction shall not52 |
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| 74 | 59 | | constitute or be considered the equivalent of an in-person, clinical examination by a53 |
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| 75 | 60 | | licensed dentist.54 |
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| 76 | 61 | | (b) No licensed dentist in this state shall provide dental care through teledentistry except55 |
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| 77 | 62 | | under the conditions specified in this Code section.56 |
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| 78 | 63 | | (c) A licensed dentist who intends to provide dental care through teledentistry pursuant to57 |
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| 79 | 64 | | this Code section shall notify the board of such intent; provide written documentation58 |
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| 80 | 65 | | evidencing that such dentist has established a referral relationship with a referred dentist59 |
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| 81 | 66 | | who practices dentistry and treats patients in a physical and operational dental office60 |
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| 82 | 67 | | located in this state within 50 miles of the setting where the teledentistry interaction shall61 |
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| 83 | 68 | | occur, provided that if no such office is available, then the closest dental office within the62 |
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| 84 | 69 | | state; and provide any other pertinent information as prescribed by the board.63 |
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| 85 | 70 | | (d) Subject to the conditions specified in subsection (e) of this Code section, an64 |
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| 86 | 71 | | authorizing dentist shall only be allowed to:65 |
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| 87 | 72 | | (1) Authorize a dental hygienist to perform the specific dental hygiene functions66 |
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| 88 | 73 | | permitted under general supervision in accordance with the requirements of Code67 |
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| 89 | 74 | | Section 43-11-74, except as otherwise provided in paragraph (1) of subsection (e) of this68 |
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| 90 | 75 | | Code section;69 |
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| 93 | 77 | | (2) Prescribe a medication that is not a controlled substance for a patient receiving dental70 |
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| 94 | 78 | | care through a teledentistry interaction;71 |
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| 95 | 79 | | (3) Authorize the performance of digital scans by a dentist or dental hygienist; and72 |
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| 96 | 80 | | (4) Authorize the use of store and forward technologies to transmit patient records,73 |
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| 97 | 81 | | images, digital scans, X-rays, and other relevant health information between the74 |
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| 98 | 82 | | authorizing dentist and a dental hygienist for the purposes of evaluating a patient's oral75 |
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| 99 | 83 | | health condition and authorizing the performance of dental care permitted under this76 |
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| 100 | 84 | | Code section. The authorizing dentist shall be the custodian of all patient records for the77 |
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| 101 | 85 | | purposes of this Code section unless the patient is treated by a referred dentist. In such78 |
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| 102 | 86 | | instance, the referred dentist shall be the custodian of the patient's records associated with79 |
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| 103 | 87 | | the dental care the referred dentist provides to the patient, and such referred dentist shall80 |
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| 104 | 88 | | furnish copies of these records to the authorizing dentist.81 |
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| 105 | 89 | | (e) An authorizing dentist shall be subject to the following conditions when providing82 |
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| 106 | 90 | | dental care through teledentistry as authorized in subsection (d) of this Code section:83 |
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| 107 | 91 | | (1) Teledentistry services shall be consistent with how dental treatment is provided in84 |
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| 108 | 92 | | person and shall adhere to the standards of appropriate patient care required in other85 |
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| 109 | 93 | | dental care settings, including, but not limited to, appropriate patient examination, the86 |
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| 110 | 94 | | taking and review of X-rays, and review of a patient's medical and dental history;87 |
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| 111 | 95 | | (2)(A) As part of the initial consultation with all new patients, the authorizing dentist88 |
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| 112 | 96 | | shall establish a bona fide dentist-patient relationship by reviewing the patient's medical89 |
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| 113 | 97 | | and dental history and verifying the patient's identity and physical location to ensure the90 |
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| 114 | 98 | | patient is physically located in this state when dental care is provided and shall obtain91 |
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| 115 | 99 | | the requisite consent from a parent or guardian if the patient is a minor.92 |
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| 116 | 100 | | (B) Except as provided for in subparagraph (C) of this paragraph, prior to practicing93 |
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| 117 | 101 | | and authorizing teledentistry in this state, the authorizing dentist shall perform the94 |
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| 118 | 102 | | initial consultation with the patient in person, which shall include a clinical examination95 |
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| 121 | 104 | | of the patient, and such in-person clinical examination shall be performed at a minimum96 |
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| 122 | 105 | | of every 12 months by the authorizing dentist.97 |
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| 123 | 106 | | (C) In board approved dental facilities and offsite locations of the Department of Public98 |
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| 124 | 107 | | Health, county boards of health, or the Department of Corrections; Title I schools under99 |
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| 125 | 108 | | the federal Elementary and Secondary Education Act; schools in which at least100 |
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| 126 | 109 | | 65 percent of the student population is eligible for free or reduced price lunch under101 |
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| 127 | 110 | | federal guidelines; Head Start programs; Georgia's Pre-K Program; hospitals; nursing102 |
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| 128 | 111 | | homes; long-term care facilities; rural health clinics; federally qualified health centers;103 |
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| 129 | 112 | | health facilities operated by federal, state, county, or local governments; hospices;104 |
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| 130 | 113 | | family violence shelters as defined in Code Section 19-13-20; and free health clinics105 |
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| 131 | 114 | | as defined in Code Section 51-1-29.4, the authorizing dentist may perform the initial106 |
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| 132 | 115 | | consultation with the patient either through an in-person, clinical examination of the107 |
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| 133 | 116 | | patient or through synchronous, real-time communication or asynchronous108 |
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| 134 | 117 | | communication involving the authorizing dentist, dental hygienist, and patient as109 |
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| 135 | 118 | | permitted under this Code section;110 |
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| 136 | 119 | | (3) The authorizing dentist shall prepare a written authorization, which shall be given to111 |
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| 137 | 120 | | the patient and included in the patient's record, providing the name and license number112 |
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| 138 | 121 | | of the authorizing dentist and the name and license number of the dental hygienist113 |
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| 139 | 122 | | treating the patient during the teledentistry interaction, as well as any other information114 |
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| 140 | 123 | | the authorizing dentist or board deems appropriate;115 |
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| 141 | 124 | | (4) Prior to each teledentistry interaction, informed consent shall be obtained from the116 |
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| 142 | 125 | | patient, or from the parent or guardian if the patient is a minor, explaining the alternatives117 |
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| 143 | 126 | | to and the capabilities and limitations of teledentistry, which shall include a written118 |
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| 144 | 127 | | statement advising that a teledentistry interaction is not equivalent to an in-person,119 |
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| 145 | 128 | | clinical examination, and that the authorizing dentist shall not be physically present120 |
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| 146 | 129 | | during the delivery of dental care. Such informed consent shall also be documented and121 |
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| 147 | 130 | | included in the patient's record;122 |
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| 150 | 132 | | (5) The authorizing dentist shall provide dental services through teledentistry only if123 |
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| 151 | 133 | | such dental services are appropriate for the patient, as determined by such authorizing124 |
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| 152 | 134 | | dentist;125 |
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| 153 | 135 | | (6)(A) The authorizing dentist shall provide the name, license number, office mailing126 |
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| 154 | 136 | | address, and office phone number of the referred dentist to the patient after each127 |
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| 155 | 137 | | teledentistry interaction.128 |
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| 156 | 138 | | (B) The referred dentist shall accept a referral to treat all dental emergencies and129 |
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| 157 | 139 | | provide all necessary dental care, as determined by and in consultation with the130 |
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| 158 | 140 | | authorizing dentist.131 |
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| 159 | 141 | | (C) The authorizing dentist shall submit updated documentation to the board regarding132 |
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| 160 | 142 | | any changes to the referral relationship within 30 days of any such changes; provided,133 |
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| 161 | 143 | | however, that documentation of a referral relationship shall not be required if the134 |
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| 162 | 144 | | authorizing dentist shall also be providing in-person dental care;135 |
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| 163 | 145 | | (7)(A) An authorizing dentist may only authorize up to four dental hygienists to136 |
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| 164 | 146 | | perform the functions permitted in subsection (d) of this Code section at any one time.137 |
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| 165 | 147 | | (B) Any dental hygienist performing the functions permitted in subsection (d) of this138 |
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| 166 | 148 | | Code section via teledentistry shall have at least two years of experience in the practice139 |
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| 167 | 149 | | of dental hygiene, shall be in compliance with continuing education requirements140 |
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| 168 | 150 | | pursuant to Code Section 43-11-73.1 and cardiopulmonary resuscitation certification141 |
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| 169 | 151 | | requirements contained in Code Section 43-11-73, and shall be licensed in good142 |
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| 170 | 152 | | standing.143 |
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| 171 | 153 | | (C) Any dental hygienist practicing under general supervision via teledentistry144 |
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| 172 | 154 | | pursuant to this Code section shall maintain professional liability insurance in145 |
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| 173 | 155 | | accordance with board rules and regulations; provided, however, that this subparagraph146 |
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| 174 | 156 | | shall not apply to an entity covered under sovereign immunity;147 |
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| 175 | 157 | | (8) No authorizing dentist or dental hygienist shall attempt to waive liability for148 |
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| 176 | 158 | | teledentistry services in advance of delivering such services, and no authorizing dentist149 |
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| 179 | 160 | | or dental hygienist shall attempt to prevent a patient from filing any complaint with any150 |
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| 180 | 161 | | governmental agency or authority relating to the provision of dental care through151 |
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| 181 | 162 | | teledentistry; and152 |
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| 182 | 163 | | (9) The authorizing dentist shall ensure that the use of teledentistry complies with the153 |
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| 183 | 164 | | privacy and security requirements of the federal Health Insurance Portability and154 |
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| 184 | 165 | | Accountability Act of 1996, as well as those of Chapter 33 of Title 31.155 |
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| 185 | 166 | | (f) Nothing in this Code section shall be construed to:156 |
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| 186 | 167 | | (1) Require a licensed dentist in this state to practice teledentistry;157 |
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| 187 | 168 | | (2) Require a licensed dentist to authorize a dental hygienist to perform the functions158 |
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| 188 | 169 | | permitted in this Code section via teledentistry;159 |
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| 189 | 170 | | (3) Require a school or facility receiving dental hygiene services provided pursuant to160 |
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| 190 | 171 | | subsection (h) or (i) of Code Section 43-11-74 to purchase any equipment to provide161 |
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| 191 | 172 | | dental care through teledentistry; or162 |
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| 192 | 173 | | (4) Expand the scope of practice for dental hygienists or establish independent dental163 |
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| 193 | 174 | | hygiene practice.164 |
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| 194 | 175 | | (g)(1) Any health insurance plan issued, amended, or renewed on or after January 1,165 |
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| 195 | 176 | | 2024, between a health insurer, contracted vendor thereof, or a care management166 |
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| 196 | 177 | | organization and a healthcare provider for the provision of healthcare services to a plan167 |
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| 197 | 178 | | enrollee shall provide coverage for the cost of dental care provided through teledentistry168 |
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| 198 | 179 | | as directed through regulations promulgated by the Department of Insurance.169 |
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| 199 | 180 | | (2) A health insurer, contracted vendor thereof, or care management organization shall170 |
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| 200 | 181 | | not:171 |
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| 201 | 182 | | (A) Exclude a service appropriately provided through teledentistry from coverage172 |
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| 202 | 183 | | solely because the service is provided through teledentistry and is not provided through173 |
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| 203 | 184 | | in-person consultation or contact between an authorizing dentist and a patient;174 |
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| 204 | 185 | | (B) Impose any annual or lifetime dollar maximum on coverage for teledentistry175 |
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| 205 | 186 | | services, other than an annual or lifetime dollar maximum that applies in the aggregate176 |
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| 208 | 188 | | to all items and services covered under the patient's policy, or impose upon any patient177 |
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| 209 | 189 | | receiving benefits pursuant to this Code section any copayment, coinsurance, or178 |
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| 210 | 190 | | deductible amounts, or any policy year, calendar year, lifetime, or other durational179 |
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| 211 | 191 | | benefit limitation or maximum for benefits or services, that is not equally imposed upon180 |
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| 212 | 192 | | all terms and services covered under the patient's health insurance policy; or181 |
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| 213 | 193 | | (C) Require its insureds to receive dental care through teledentistry in lieu of an182 |
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| 214 | 194 | | in-person, clinical examination.183 |
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| 215 | 195 | | (3) The Commissioner of Insurance shall have all powers of enforcement and sanction184 |
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| 216 | 196 | | with respect to violations of this subsection by any health insurer, contracted vendor185 |
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| 217 | 197 | | thereof, or care management organization as provided in Title 33.186 |
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| 218 | 198 | | (h) The board shall promulgate rules and regulations that are reasonably necessary to187 |
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| 219 | 199 | | implement the provisions of this Code section."188 |
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| 220 | 200 | | SECTION 2.189 |
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| 221 | 201 | | This Act shall become effective on January 1, 2025.190 |
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| 222 | 202 | | SECTION 3.191 |
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| 223 | 203 | | All laws and parts of laws in conflict with this Act are repealed.192 |
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