FILED SENATE
Feb 24, 2021
GENERAL ASSEMBLY OF NORTH CAROLINA
S.B. 146
SESSION 2021 PRINCIPAL CLERK
S D
SENATE BILL DRS15062-NB-47*
Short Title: Teledentistry/RDH Admin. Local Anesthetic. (Public)
Sponsors: Senator Perry (Primary Sponsor).
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO ESTABLISH STANDARDS FOR THE PRACTICE OF TELEDENTISTRY AND
3 TO AUTHORIZE PROPERLY TRAINED DENTAL HYGIENISTS TO ADMINISTER
4 LOCAL DENTAL ANESTHETICS UNDER DIRECT SUPERVISION OF A LICENSED
5 DENTIST.
6 The General Assembly of North Carolina enacts:
7 SECTION 1.(a) G.S. 90-29(b) reads as rewritten:
8 "(b) A person shall be deemed to be practicing dentistry in this State who does, undertakes
9 or attempts to do, or claims the ability to do any one or more of the following acts or things
10 which, for the purposes of this Article, constitute the practice of dentistry:
11 …
12 (6) Administers an anesthetic of any kind in the treatment of dental or oral
13 diseases or physical conditions, or in preparation for or incident to any
14 operation within the oral cavity; provided, however, that this subsection shall
15 not apply to a lawfully qualified nurse anesthetist who administers such
16 anesthetic under the supervision and direction of a licensed dentist or
17 physician;physician, or to a registered dental hygienist qualified to administer
18 local anesthetics.
19 …
20 (11) Owns, manages, supervises, controls or conducts, either himself or himself,
21 by and through another person or other persons, or by use of any electronic or
22 other digital means, any enterprise wherein any one or more of the acts or
23 practices set forth in subdivisions (1) through (10) above are done, attempted
24 to be done, or represented to be done;done.
25 …."
26 SECTION 1.(b) Article 2 of Chapter 90 of the General Statutes is amended by
27 adding a new section to read:
28 "§ 90-30.2. Teledentistry practice; definitions; requirements.
29 (a) The following definitions apply in this section:
30 (1) Authorized person. – An appropriate person with legal authority to make the
31 health care treatment decision for a patient.
32 (2) Licensed dental hygienist. – An individual who holds a valid license to
33 practice dental hygiene duly issued by the North Carolina Board of Dental
34 Examiners in accordance with Article 16 of this Chapter.
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1 (3) Licensed dentist. – A person who holds a valid license to practice dentistry
2 duly issued by the North Carolina Board of Dental Examiners in accordance
3 with this Article.
4 (4) Licensee. – A person who is a licensed dental hygienist or licensed dentist in
5 this State.
6 (5) Practice of teledentistry. – The provision of dental services by use of any
7 electronic or other digital means, as authorized in G.S. 90-29(b)(11) and
8 provided for in G.S. 90-30.2(b).
9 (6) Supervision. – Acts are deemed to be under the supervision of a licensed
10 dentist when performed pursuant to the licensed dentist's order, control, and
11 approval and do not require the physical presence of the licensed dentist.
12 (b) Practice of Teledentistry Requirements. – For the purposes of this Article, the practice
13 of teledentistry includes any of the following:
14 (1) Delivery of service. – Teledentistry services may be delivered by a licensed
15 dentist or a licensed dental hygienist who is under the supervision of a licensed
16 dentist. Licensees shall comply with all rules of professional conduct and
17 applicable State and federal law relevant to licensed dentists and licensed
18 dental hygienists when delivering teledentistry services.
19 (2) Encounter location. – The location of service is determined at the time
20 teledentistry services are initiated, as follows:
21 a. When the service is between patient and provider, the location of the
22 patient is the originating site, and the location of the provider is the
23 distant site.
24 b. When the service is between providers, conducted for the purposes of
25 consultation, the location of the provider initiating the consult is the
26 originating site, and the location of the consulting provider is the
27 distant site.
28 (3) Data. – Any licensee, patient, or authorized person may transmit data,
29 electronic images, and related information as appropriate to provide
30 teledentistry services to a patient.
31 (4) Patient care. – A licensee using teledentistry services in the provision of dental
32 services to a patient shall take appropriate steps to establish the
33 licensee-patient relationship, conduct all appropriate evaluations and history
34 of the patient, and provide access to comprehensive dental care where
35 clinically indicated.
36 (5) Evaluations. – Notwithstanding any provision of law to the contrary, patient
37 evaluations may be conducted by a licensed dentist using teledentistry
38 modalities.
39 (c) Informed Consent. – A licensee who provides or facilitates the use of teledentistry
40 shall ensure that the informed consent of the patient or authorized person is obtained before
41 services are provided through teledentistry. All informed consents shall be included in the
42 patient's dental records. To obtain an informed consent, the licensee shall do all of the following:
43 (1) Confirm the identity of the requesting patient.
44 (2) Verify and authenticate the patient's health history.
45 (3) Disclose the licensee's identity, applicable credentials, and contact
46 information, including a current phone number and mailing address of the
47 licensee's practice.
48 (4) Obtain an appropriate informed consent from the requesting patient after
49 disclosures have been made regarding the delivery models and treatment
50 methods and limitations, including any special informed consents regarding
51 the use of teledentistry services.
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1 (5) In addition to other areas that must be discussed in traditional in-person dental
2 encounters with a patient before treatment, the informed consent shall inform
3 the patient or authorized person and document acknowledgment of the risk
4 and limitations of all of the following:
5 a. The use of electronic communications in the provision of care.
6 b. The potential for breach of confidentiality, or inadvertent access of
7 protected health information using electronic and digital
8 communication in the use of teledentistry.
9 c. The types of activities permitted using teledentistry services.
10 (6) Inform the patient or authorized person that it is the role of the licensed dentist
11 to determine whether the condition being diagnosed or treated is appropriate
12 for a teledentistry encounter.
13 (7) Obtain written consent from the patient or authorized person to forward
14 patient-identifiable information to a third party.
15 (8) Provide the patient and authorized person with contact information for the
16 North Carolina State Board of Dental Examiners and a description of, or link
17 to, the patient complaint process.
18 (d) Confidentiality. – The licensee shall ensure that any electronic and digital
19 communication used in the practice of teledentistry is secure to maintain confidentiality of the
20 patient's medical information as required by the Health Insurance Portability and Accountability
21 Act of 1996 (HIPAA) and all other applicable laws and administrative regulations. Patients
22 receiving services through teledentistry under this section are entitled to protection of their
23 medical information no less stringent than the requirements that apply to patients receiving
24 in-person services.
25 (e) Patient Dental Records. – Records of teledentistry services provided to a patient or
26 authorized person shall be held to the same record retention standards as records of traditional
27 in-person dental encounters. A patient record established during the use of teledentistry services
28 shall be accessible to both the licensee and the patient or authorized person, consistent with all
29 established State and federal laws and regulations governing patient health care records. In
30 addition to other areas that must be included in traditional in-person dental encounters, the
31 licensee shall document or record in the patient dental record all of the following:
32 (1) The patient's presenting problem.
33 (2) The patient's diagnosis.
34 (3) The patient's treatment plan.
35 (4) A description of all services that were provided through teledentistry.
36 (f) Prescribing. – The indication, appropriateness, and safety considerations for each
37 prescription for medication, laboratory services, or dental laboratory services provided through
38 the use of teledentistry shall be evaluated by the licensed dentist in accordance with applicable
39 law and current standards of care, including those for appropriate documentation. A licensed
40 dentist's use of teledentistry carries the same professional accountability as a prescription issued
41 in connection with an in-person encounter. A licensed dentist who prescribes any type of
42 analgesic or pain medication as part of the provision of teledentistry services shall comply with
43 all applicable North Carolina Controlled Substance Reporting System requirements."
44 SECTION 1.(c) G.S. 90-41 reads as rewritten:
45 "§ 90-41. Disciplinary action.
46 (a) The North Carolina State Board of Dental Examiners shall have the power and
47 authority to (i) Refuse to issue a license to practice dentistry; (ii) Refuse to issue a certificate of
48 renewal of a license to practice dentistry; (iii) Revoke or suspend a license to practice dentistry;
49 and (iv) Invoke such other disciplinary measures, censure, or probative terms against a licensee
50 as it deems fit and proper;
51 in any instance or instances in which the Board is satisfied that such applicant or licensee:
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1 …
2 (25) Has distributed or caused to be distributed any intoxicant, drug or narcotic for
3 any other than a lawful purpose; or
4 (26) Has engaged in any unprofessional conduct as the same may be, from time to
5 time, defined by the rules and regulations of the Board.Board;
6 (27) Has allowed fee-splitting for the use of teledentistry services; or
7 (28) Has limited, in any way, a patient's right or ability to raise grievances or file
8 complaints with any appropriate oversight body, including the North Carolina
9 State Board of Dental Examiners, the North Carolina Department of Justice,
10 Division of Medicaid Investigations, and the North Carolina Department of
11 Health and Human Services, Division of Health Benefits, Office of
12 Compliance and Program Integrity.
13 …."
14 SECTION 2.(a) G.S. 90-221(a) reads as rewritten:
15 "(a) "Dental hygiene" as used in this Article shall mean the performance of the following
16 functions: Complete oral prophylaxis, application of preventive agents to oral structures,
17 exposure and processing of radiographs, administration of medicaments prescribed by a licensed
18 dentist, preparation of diagnostic aids, and written records of oral conditions for interpretation
19 by the dentist, together with such other and further functions as may be permitted by rules and
20 regulations of the Board not inconsistent herewith. Notwithstanding the provisions of
21 G.S. 90-29(b)(6), dental hygiene shall include the administration of local anesthetics by
22 infiltration and block techniques by dental hygienists certified pursuant to G.S. 90-225.2, if a
23 dental hygienist conducts administration of local anesthetics under the direct supervision of a
24 dentist licensed to practice dentistry under Article 2 of this Chapter."
25 SECTION 2.(b) G.S. 90-221 is amended by adding a new subsection to read:
26 "(b1) "Direct supervision" as used in this Article shall mean that acts are deemed to be under
27 required supervision only when performed in a locale where the supervising licensed dentist is
28 physically present and shall not include supervision under G.S. 90-233(a) and (a1)."
29 SECTION 2.(c) Article 16 of Chapter 90 of the General Statutes is amended by
30 adding a new section to read:
31 "§ 90-225.2. Current hygiene students in CODA-approved curriculum programs.
32 Programs required for dental hygienists licensed in this State to qualify to administer local
33 anesthetics pursuant to G.S. 90-221(a) shall be taught using lecture and laboratory or clinical
34 formats at the University of North Carolina School of Dentistry, the East Carolina University
35 School of Dental Medicine, or a dental hygiene program accredited by the Council on Dental
36 Accreditation (CODA), or a similar organization approved by the United States Department of
37 Education. The training program will include, at a minimum, a 30-hour session composed of 16
38 didactic hours and 14 clinical hours. Clinical instruction shall be provided by a dentist holding a
39 DDS or DMD degree, and the faculty to student ratio shall be no greater than 1:5 for the
40 laboratory and clinical instruction. Courses must be taught to a minimum score of eighty percent
41 (80%) in the parenteral administration of local anesthesia, and successful students shall be
42 awarded a certificate of completion."
43 SECTION 2.(d) Article 16 of Chapter 90 of the General Statutes is amended by
44 adding a new section to read:
45 "§ 90-225.3. Requirements to administer local anesthetics for licensed dental hygienists;
46 reciprocity.
47 (a) The Board may approve a dental hygienist licensed in this State or any other state or
48 territory to provide local anesthesia upon the dental hygienist meeting all of the following criteria:
49 (1) Produces satisfactory evidence of the required education, training, and clinical
50 qualifications to provide local anesthesia.
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1 (2) Has been practicing dental hygiene, as defined in G.S. 90-221, under the
2 supervision of a licensed dentist for a minimum of two years immediately
3 preceding the date of the application.
4 (3) Has successfully completed a course of study on local anesthetics offered
5 through a school or college approved by the United States Department of
6 Education or a Board-approved continuing education provider that includes
7 all of the following:
8 a. A minimum of 16 lecture hours on pharmacology, physiology,
9 equipment, block and infiltration techniques, legal issues, and medical
10 emergencies, including systemic complications.
11 b. A minimum of eight clinical hours of instruction and experience in
12 administering local anesthesia injections.
13 c. Completion of at least 12 block and 12 infiltration injections under the
14