Bill Analysis - Senate Bill 146, Teledentistry/RDH Admin. Local Anesthetic (March 23, 2021)

Summary

Bill analysis of Senate Bill 146, Teledentistry/RDH Admin. Local Anesthetic, 2021-2022 General Assembly, for the Senate Commerce and Insurance committee, dated March 23, 2021, introduced by Sen. Perry and prepared by Amy Darden, Committee Counsel, as an analysis of the Second Edition. The overview states the bill would establish standards for teledentistry, allow dental hygienists to administer local anesthetics under the direct supervision of a licensed dentist, and allow certain dental hygienists to practice at schools without a licensed dentist physically present. Training programs would include at least 16 classroom hours and 14 clinical hours. Section 2 of the bill would be effective October 1, 2021.

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Full text

                                                     SENATE BILL 146:
                                                     Teledentistry/RDH Admin. Local Anesthetic.
      2021-2022 General Assembly
     Committee:     Senate Commerce and Insurance. If favorable, Date:          March 23, 2021
                    re-refer to Rules and Operations of the Senate
     Introduced by: Sen. Perry                                     Prepared by: Amy Darden*
     Analysis of:   Second Edition                                              Committee Counsel

     OVERVIEW: Senate Bill 146 would establish standards for teledentistry, allow dental hygienists to
     administer local anesthetics while under the direct supervision of a licensed dentist, and allow certain
     dental hygienists to practice at schools without a licensed dentist physically present.
     CURRENT LAW: Under current law, dental hygienists may not administer local anesthetic, and there
     are currently no statutory standards for teledentistry.
     Dental hygienists who meet the following requirements may perform dental hygiene functions without
     the physical presence of a dentist if the services are performed in nursing homes, rest homes, long-care
     facilities, rural and community clinics operated by Board-approved nonprofits, federal, State, county or
     local governments:
            ➢ 3 years of experience or a minimum of 2,000 hours under the supervision of a licensed dentist.
            ➢ Completion of annual CPR certification.
            ➢ Completion of six hours of continuing education in medical emergencies, in addition to the
              standard continuing education requirements.
            ➢ Designated by the employing dentist as being capable of performing clinical hygiene procedures
              without direct supervision of the dentist.


     BILL ANALYSIS:
     Section 1.(a) would amend the practice of dentistry in G.S. 90-29(b) to permit dental hygienists to
     administer local anesthetics and to allow dentists to engage in teledentistry.
     Section 1.(b) would create a new section in the Dental Practice Act (Article 2 of Chapter 90) establishing
     standards for the practice of teledentistry. The new section would do the following:
            •     Create definitions for "authorized person," "licensed dental hygienist," "licensee," "practice of
                  teledentistry," and "supervision."
            •     Allow teledentistry services to be offered by a licensed dentist or a dental hygienist under the
                  supervision of a licensed dentist, define the location where services are provided, permit
                  transmission of data related to dental care, and require licensees to provide all teledentistry services
                  in accordance with the normal dental standards of care.
            •     Require licensees to (i) confirm the patient's identity, (ii) authenticate the patient's health history,
                  (iii) disclose their credentials, (iv) inform the patient of the risks of teledentistry, (v) inform the

                                                                                                                                                             Legislative Analysis
     Jeffrey Hudson
                                                                                                                                                                   Division
         Director                                           S146-SMBB-12(e2)-v-3                                                                               919-733-2578
This bill analysis was prepared by the nonpartisan legislative staff for the use of legislators in their deliberations and does not constitute an official statement of legislative intent.
Senate Bill 146
Page 2

         patient that not all conditions may be appropriate for teledental care, and (vi) and provide the
         patient the contact information for the North Carolina State Board of Dental Examiners (Board) as
         part of obtaining informed consent for treatment. A record of this informed consent would have
         to be maintained in the patient's records.
    •    Ensure that all records and data transmissions conform to HIPAA requirements.
    •    Maintain the same records retention standards as are required for in-person care.
    •    Require licensees to comply with all North Carolina Controlled Substance Reporting System
         requirements.
Section 1.(c) would allow the Board to take disciplinary action against licensees who allow fee-splitting
in the provision of teledentistry services or who limit a patient's ability to file a grievance with any
appropriate oversight body.
Section 2.(a) would amend the definition of "dental hygiene" in G.S. 90-221(a) to include a dental
hygienist's administration of local anesthetics by means of infiltration and block techniques while under
the direct supervision of a licensed dentist.
Section 2.(b) would add a definition for "direct supervision" to G.S. 90-221.
Section 2.(c) would require programs training dental hygienists to administer local anesthetics to include
at least 16 classroom hours and 14 clinical hours. The faculty to student ratio must be no more than 1:5,
and students must receive a score of at least 80% in order to successfully complete the course.
Section 2.(d) would allow the Board to license dental hygienists to administer local anesthetic if they (i)
provide evidence of required education, training, and clinical qualifications, (ii) have been practicing
dental hygiene for at least 2 years, and (iii) have completed the required education and have administered
at least 12 block injections and 12 infiltration injections. Hygienists who are licensed to administer local
anesthetic would be required to maintain current CPR training and complete two hours of continuing
education each year.
Section 3 would allow certain dental hygienists to practice dental hygiene at schools without a licensed
dentist being physical present.
Section 4 would allow the Board to adopt temporary rules necessary to implement the provisions of the
bill.
EFFECTIVE DATE: Section 2 of the bill would be effective October 1, 2021, and apply to licenses
granted on or after that date. The remainder of the bill would be effective when it becomes law.
**Jason Moran-Bates, Staff Attorney, substantially contributed to this summary.


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