24 LC 52 0520S/AP
House Bill 441 (AS PASSED HOUSE AND SENATE)
By: Representatives Dempsey of the 13
th
, Hawkins of the 27
th
, Hatchett of the 155
th
,
Anulewicz of the 42
nd
, Mathis of the 149
th
, and others
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 11 of Title 43 of the Official Code of Georgia Annotated, relating to
1
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 to perform5
teledentistry; to require health insurers to cover dental care provided through teledentistry;6
to prohibit health insurers from requiring covered persons to obtain dental care through7
teledentistry; to provide for enforcement by the Commissioner of Insurance regarding8
insurance coverage of teledentistry; to provide for the Georgia Board of Dentistry to9
promulgate rules and regulations; to provide for related matters; to provide an effective date;10
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) 'General supervision' shall have the same meaning as in Code Section 43-11-74.29
(7) 'Health insurance plan' shall have the same meaning as in Code Section 33-24-59.24.30
(8) 'Health insurer' shall have the same meaning as in Code Section 33-24-59.24.31
(9) 'Referred dentist' means a licensed dentist practicing in this state who has a written32
agreement with an authorizing dentist to provide in-person dental treatment to patients33
receiving dental care through a teledentistry interaction under this Code section.34
(10) 'Store and forward technologies' means technologies that allow for the electronic35
transmission of dental and health information, including images, photographs,36
documents, and health histories, through a secure communication system.37
(11) 'Synchronous, real-time communication' means a live, two-way interaction between38
the authorizing dentist and a dental hygienist or patient permitted under this Code section39
using audiovisual telecommunications technology but shall not constitute direct40
supervision for the purposes of Code Section 43-11-74 and the practice of dentistry in this41
state.42
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(12) 'Teledentistry' means the delivery of dental care through the use of synchronous,43
real-time communication in conjunction with and supported by store and forward44
technologies under the general supervision of the authorizing dentist when dental care is45
provided to a patient physically located at a site in this state that is different from the site46
where the authorizing dentist is physically located. Teledentistry shall not include when47
a licensed dentist providing dental care to patients in a private dental office receives a48
digital photograph or audio or video communication from the cellphone of a patient of49
record for the purpose of evaluating a dental emergency or providing palliative care until50
the patient can be treated by such dentist. Such dentist shall not charge the patient for51
such emergency evaluation or palliative care. A teledentistry interaction shall not52
constitute or be considered the equivalent of an in-person, clinical examination by a53
licensed dentist.54
(b) No licensed dentist in this state shall provide dental care through teledentistry except55
under the conditions specified in this Code section.56
(c) A licensed dentist who intends to provide dental care through teledentistry pursuant to57
this Code section shall notify the board of such intent; provide written documentation58
evidencing that such dentist has established a referral relationship with a referred dentist59
who practices dentistry and treats patients in a physical and operational dental office60
located in this state within 50 miles of the setting where the teledentistry interaction shall61
occur, provided that if no such office is available, then the closest dental office within the62
state; and provide any other pertinent information as prescribed by the board.63
(d) Subject to the conditions specified in subsection (e) of this Code section, an64
authorizing dentist shall only be allowed to:65
(1) Authorize a dental hygienist to perform the specific dental hygiene functions66
permitted under general supervision in accordance with the requirements of Code67
Section 43-11-74, except as otherwise provided in paragraph (1) of subsection (e) of this68
Code section;69
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(2) Prescribe a medication that is not a controlled substance for a patient receiving dental70
care through a teledentistry interaction;71
(3) Authorize the performance of digital scans by a dentist or dental hygienist; and72
(4) Authorize the use of store and forward technologies to transmit patient records,73
images, digital scans, X-rays, and other relevant health information between the74
authorizing dentist and a dental hygienist for the purposes of evaluating a patient's oral75
health condition and authorizing the performance of dental care permitted under this76
Code section. The authorizing dentist shall be the custodian of all patient records for the77
purposes of this Code section unless the patient is treated by a referred dentist. In such78
instance, the referred dentist shall be the custodian of the patient's records associated with79
the dental care the referred dentist provides to the patient, and such referred dentist shall80
furnish copies of these records to the authorizing dentist.81
(e) An authorizing dentist shall be subject to the following conditions when providing82
dental care through teledentistry as authorized in subsection (d) of this Code section:83
(1) Teledentistry services shall be consistent with how dental treatment is provided in84
person and shall adhere to the standards of appropriate patient care required in other85
dental care settings, including, but not limited to, appropriate patient examination, the86
taking and review of X-rays, and review of a patient's medical and dental history;87
(2)(A) As part of the initial consultation with all new patients, the authorizing dentist88
shall establish a bona fide dentist-patient relationship by reviewing the patient's medical89
and dental history and verifying the patient's identity and physical location to ensure the90
patient is physically located in this state when dental care is provided and shall obtain91
the requisite consent from a parent or guardian if the patient is a minor.92
(B) Except as provided for in subparagraph (C) of this paragraph, prior to practicing93
and authorizing teledentistry in this state, the authorizing dentist shall perform the94
initial consultation with the patient in person, which shall include a clinical examination95
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of the patient, and such in-person clinical examination shall be performed at a minimum96
of every 12 months by the authorizing dentist.97
(C) In 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 may perform the initial106
consultation with the patient either through an in-person, clinical examination of the107
patient or through synchronous, real-time communication or asynchronous108
communication involving the authorizing dentist, dental hygienist, and patient as109
permitted under this Code section;110
(3) The authorizing dentist shall prepare a written authorization, which shall be given to111
the patient and included in the patient's record, providing the name and license number112
of the authorizing dentist and the name and license number of the dental hygienist113
treating the patient during the teledentistry interaction, as well as any other information114
the authorizing dentist or board deems appropriate;115
(4) Prior to each teledentistry interaction, informed consent shall be obtained from the116
patient, or from the parent or guardian if the patient is a minor, explaining the alternatives117
to and the capabilities and limitations of teledentistry, which shall include a written118
statement advising that a teledentistry interaction is not equivalent to an in-person,119
clinical examination, and that the authorizing dentist shall not be physically present120
during the delivery of dental care. Such informed consent shall also be documented and121
included in the patient's record;122
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(5) The authorizing dentist shall provide dental services through teledentistry only if123
such dental services are appropriate for the patient, as determined by such authorizing124
dentist;125
(6)(A) The authorizing dentist shall provide the name, license number, office mailing126
address, and office phone number of the referred dentist to the patient after each127
teledentistry interaction.128
(B) The referred dentist shall accept a referral to treat all dental emergencies and129
provide all necessary dental care, as determined by and in consultation with the130
authorizing dentist.131
(C) The authorizing dentist shall submit updated documentation to the board regarding132
any changes to the referral relationship within 30 days of any such changes; provided,133
however, that documentation of a referral relationship shall not be required if the134
authorizing dentist shall also be providing in-person dental care;135
(7)(A) An authorizing dentist may only authorize up to four dental hygienists to136
perform the functions permitted in subsection (d) of this Code section at any one time.137
(B) Any dental hygienist performing the functions permitted in subsection (d) of this138
Code section via teledentistry shall have at least two years of experience in the practice139
of dental hygiene, shall be in compliance with continuing education requirements140
pursuant to Code Section 43-11-73.1 and cardiopulmonary resuscitation certification141
requirements contained in Code Section 43-11-73, and shall be licensed in good142
standing.143
(C) Any dental hygienist practicing under general supervision via teledentistry144
pursuant to this Code section shall maintain professional liability insurance in145
accordance with board rules and regulations; provided, however, that this subparagraph146
shall not apply to an entity covered under sovereign immunity;147
(8) No authorizing dentist or dental hygienist shall attempt to waive liability for148
teledentistry services in advance of delivering such services, and no authorizing dentist149
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or dental hygienist shall attempt to prevent a patient from filing any complaint with any150
governmental agency or authority relating to the provision of dental care through151
teledentistry; and152
(9) The authorizing dentist shall ensure that the use of teledentistry complies with the153
privacy and security requirements of the federal Health Insurance Portability and154
Accountability Act of 1996, as well as those of Chapter 33 of Title 31.155
(f) Nothing in this Code section shall be construed to:156
(1) Require a licensed dentist in this state to practice teledentistry;157
(2) Require a licensed dentist to authorize a dental hygienist to perform the functions158
permitted in this Code section via teledentistry;159
(3) Require a school or facility receiving dental hygiene services provided pursuant to160
subsection (h) or (i) of Code Section 43-11-74 to purchase any equipment to provide161
dental care through teledentistry; or162
(4) Expand the scope of practice for dental hygienists or establish independent dental163
hygiene practice.164
(g)(1) Any health insurance plan issued, amended, or renewed on or after January 1,165
2024, between a health insurer, contracted vendor thereof, or a care management166
organization and a healthcare provider for the provision of healthcare services to a plan167
enrollee shall provide coverage for the cost of dental care provided through teledentistry168
as directed through regulations promulgated by the Department of Insurance.169
(2) A health insurer, contracted vendor thereof, or care management organization shall170
not:171
(A) Exclude a service appropriately provided through teledentistry from coverage172
solely because the service is provided through teledentistry and is not provided through173
in-person consultation or contact between an authorizing dentist and a patient;174
(B) Impose any annual or lifetime dollar maximum on coverage for teledentistry175
services, other than an annual or lifetime dollar maximum that applies in the aggregate176
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to all items and services covered under the patient's policy, or impose upon any patient177
receiving benefits pursuant to this Code section any copayment, coinsurance, or178
deductible amounts, or any policy year, calendar year, lifetime, or other durational179
benefit limitation or maximum for benefits or services, that is not equally imposed upon180
all terms and services covered under the patient's health insurance policy; or181
(C) Require its insureds to receive dental care through teledentistry in lieu of an182
in-person, clinical examination.183
(3) The Commissioner of Insurance shall have all powers of enforcement and sanction184
with respect to violations of this subsection by any health insurer, contracted vendor185
thereof, or care management organization as provided in Title 33.186
(h) The board shall promulgate rules and regulations that are reasonably necessary to187
implement the provisions of this Code section."188
SECTION 2.189
This Act shall become effective on January 1, 2025.190
SECTION 3.191
All laws and parts of laws in conflict with this Act are repealed.192
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