PRINTER'S NO. 1644
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1457
Session of
2023
INTRODUCED BY MULLINS, HILL-EVANS, MADDEN, SANCHEZ AND CERRATO,
JUNE 21, 2023
REFERRED TO COMMITTEE ON INSURANCE, JUNE 21, 2023
AN ACT
Amending the act of May 1, 1933 (P.L.216, No.76), entitled "An
act relating to dentistry; defining and providing for the
licensing and registration of dentists and dental hygienists,
and for the revocation and suspension of such licenses and
registrations, subject to appeal, and for their
reinstatement; defining the powers and duties of the State
Dental Council and Examining Board and the Department of
Public Instruction; providing penalties; and repealing
existing laws," further providing for definitions; providing
for medical loss ratio; and making editorial changes.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 1, 1933 (P.L.216, No.76), known as
The Dental Law, is amended by adding sections to read:
Section 1.1. Definitions.-- The following words and phrases
when used in this act shall have the meanings given to them in
this section unless the context clearly indicates otherwise:
"Analgesia." The diminution or elimination of pain in a
conscious patient.
"Board." The State Board of Dentistry of the Commonwealth.
"Community-based clinic." An organized clinic offering
primary health services to low-income individuals or to
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residents in medically underserved areas or health professional
shortage areas. The term includes a State health center, a
nonprofit community-based clinic and a federally qualified
health center.
"Conscious sedation." A minimally depressed level of
consciousness which retains a patient's ability to independently
and continuously maintain an airway and respond appropriately to
physical stimulation or verbal command, produced by a
pharmacologic or nonpharmacologic method, or combination
thereof.
"Dental benefit plan." A benefits plan which pays or
provides dental expense benefits for covered dental services and
is delivered or issued for delivery by or through a dental
carrier on a stand-alone basis. Some health insurers or health
insurance plans integrate dental benefits and should be
considered dental benefits plans for the purposes of this act
and in the provisions therein.
"Dental hygienist." An individual who is legally licensed as
such by the State Board of Dentistry to perform those
educational, preventive and therapeutic services and procedures
that licensed dental hygienists are educated to perform.
Licensed dentists may assign to dental hygienists intra-oral
procedures which the hygienists have been educated to perform
and which require their professional competence and skill but
which do not require the professional competence and skill of
the dentist. Such assignments shall be under the supervision of
a licensed dentist. Such performance of intra-oral procedures by
licensed dental hygienists shall be in the private office of a
dentist or public or private institution such as prescribed
under section 11.9(b). Dental hygienists certified as public
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health dental hygiene practitioners may perform intra-oral
procedures without the assignment of a dentist pursuant to
section 11.9. The foregoing shall not be construed as
authorizing the assignment of diagnosing, treatment planning and
writing prescriptions for drugs or writing authorizations for
restorative, prosthetic or orthodontic appliances. The board
shall issue rules setting forth the necessary education and
defining the procedures that may be performed by dental
hygienists licensed under this act including those procedures
that may be performed under direct and general supervision.
"Dental services." Services for the diagnosis, prevention,
treatment or cure of a dental condition, illness, injury or
disease. The term does not include those services delivered by a
provider that are billed as medical services.
"Expanded function dental assistant." An individual who
holds a current valid certification under this act to perform
reversible intra-oral procedures authorized by this act under
the direct supervision of a licensed dentist and under an
assignment of duties by a dentist, as defined in section 11.8.
An expanded function dental assistant may, under direct
supervision, perform those procedures specified in section 11.10
and other reversible procedures not designated by this act to be
performed by licensed dentists or dental hygienists. For
purposes of this definition, "direct supervision" shall mean
that a dentist is in the dental office or treatment facility,
personally diagnoses the condition to be treated, personally
authorizes the procedure and remains in the dental office or
treatment facility while the procedure is being performed and,
before dismissal of the patient, personally evaluates the work
performed.
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"Foreign dental schools." The dental schools which have not
been approved by the Commission on Accreditation of the American
Dental Association and are located in countries other than the
United States or Canada.
"General anesthesia." A controlled state of unconsciousness,
including deep sedation, accompanied by the partial or complete
loss of protective reflexes which includes the patient's
inability to independently maintain an airway and respond
purposefully to physical stimulation or verbal command, produced
by a pharmacologic or nonpharmacologic method, or combination
thereof.
"Health care service plan." Any of the following:
(1) A hospital or medical insurance policy or certificate.
(2) A qualified higher deductible health plan.
(3) A health maintenance organization subscriber contract.
(4) A contract providing benefits for dental care whether
such contract is pursuant to a medical insurance policy or
certificate.
(5) A stand-alone dental plan, health maintenance provider
contract or managed health care plan.
"Practice of dentistry." As defined in section 1.2.
"Public health dental hygiene practitioner." A licensed
dental hygienist who may perform educational, preventive,
therapeutic and intra-oral procedures which the hygienist is
educated to perform and which require the hygienist's
professional competence and skill but which do not require the
professional competence and skill of a dentist without the
authorization, assignment or examination of a dentist, and who
is certified by the State Board of Dentistry as having satisfied
the requirements of section 11.9. Public health dental hygiene
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practitioners may only engage in professional practice in the
practice sites enumerated in section 11.9(b).
"Restricted faculty license." A license granted to an
individual for the limited purpose of teaching, including
clinical teaching, in a dental school or advanced dental
education program as a faculty member at an accredited dental
school in this Commonwealth.
"Volunteer licensee." A license issued to qualified
individuals who retire from active practice and seek to provide
professional services as a volunteer in community-based clinics
without remuneration.
Section 1.2. Practice of Dentistry.--A person engages in the
"Practice of Dentistry," within the meaning of this act, who
diagnoses, treats, operates on, or prescribes for any disease,
pain or injury, or regulates any deformity or physical
condition, of the human teeth, jaws or associated structures, or
conducts a physical evaluation, or administers anesthetic
agents, or uses ionizing radiation in the course of dental
practice, or who fits, constructs and inserts any artificial
appliance, plate or denture for the human teeth or jaws, or who
holds himself or herself out as being able or legally authorized
to do so. The term "Practice of Dentistry" includes the practice
of dentistry under a restricted faculty license. The term
"Practice of Dentistry" does not include:
(1) The practice of any of the healing arts by duly licensed
practitioners.
(2) The extracting of teeth or relieving pain by a licensed
physician or surgeon in emergencies, or the making of
applications for such purposes.
(3) The practice of dentistry by a duly licensed
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practitioner of dentistry of any other state or country, for the
limited purpose of consultation with respect to any case under
treatment in this Commonwealth, or of demonstrating before any
duly authorized dental society in this Commonwealth.
(4) The practice of dentistry in clinical departments and
laboratories of dental schools and their affiliated facilities
approved by the board in the Commonwealth, by bona fide students
pursuing a course of study leading to the degree of Doctor of
Dental Surgery or Doctor of Dental Medicine.
(5) The practice of dentistry in a dental clinic operated
not for profit for the duration of an internship, residency or
other graduate training program approved by the American Dental
Association Commission on Dental Accreditation or a dental
anesthesiology training program that meets the standards of an
accrediting body acceptable to the board, by persons having
acquired the preliminary and professional education required for
admission into the program, after notification to the board.
(6) The practice of dentistry in a clinical continuing
education course offered by a dental school in this Commonwealth
for a duration of twenty days or less, either continuous or in
several sessions, where dentists licensed in the United States
or other countries work under the direct supervision of dentists
licensed by the Commonwealth, and delivered within the
educational facilities of a dental school in this Commonwealth
that is approved by the American Dental Association Commission
on Dental Accreditation.
Section 2. Section 2 of the act is repealed:
[Section 2. Definitions.--A person engages in the "Practice
of Dentistry," within the meaning of this act, who diagnoses,
treats, operates on, or prescribes for any disease, pain or
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injury, or regulates any deformity or physical condition, of the
human teeth, jaws, or associated structures, or conducts a
physical evaluation, or administers anesthetic agents, or uses
ionizing radiation in the course of dental practice, or who
fits, constructs, and inserts any artificial appliance, plate,
or denture for the human teeth or jaws, or who holds himself or
herself out as being able or legally authorized to do so. The
term "Practice of Dentistry" includes the practice of dentistry
under a restricted faculty license. The term "Practice of
Dentistry" does not include:
(a) The practice of any of the healing arts by duly licensed
practitioners.
(b) The extracting of teeth or relieving pain by a licensed
physician or surgeon in emergencies, or the making of
applications for such purposes.
(c) The practice of dentistry by a duly licensed
practitioner of dentistry of any other state or country, for the
limited purpose of consultation with respect to any case under
treatment in this Commonwealth, or of demonstrating before any
duly authorized dental society in this Commonwealth.
(e) The practice of dentistry in clinical departments and
laboratories of dental schools and their affiliated facilities
approved by the board in the Commonwealth, by bona fide students
pursuing a course of study leading to the degree of Doctor of
Dental Surgery or Doctor of Dental Medicine.
(f) The practice of dentistry in a dental clinic operated
not for profit for the duration of an internship, residency or
other graduate training program approved by the American Dental
Association Commission on Dental Accreditation or a dental
anesthesiology training program that meets the standards of an
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accrediting body acceptable to the board, by persons having
acquired the preliminary and professional education required for
admission into the program, after notification to the board.
(g) The practice of dentistry in a clinical continuing
education course offered by a dental school in this Commonwealth
for a duration of twenty days or less, either continuous or in
several sessions, where dentists licensed in the United States
or other countries work under the direct supervision of dentists
licensed by the Commonwealth, and delivered within the
educational facilities of a dental school in this Commonwealth
that is approved by the American Dental Association Commission
on Dental Accreditation.
"Community-based Clinic" means an organized clinic offering
primary health services to low-income individuals or to
residents in medically underserved areas or health professional
shortage areas. The term includes a State health center, a
nonprofit community-based clinic and a federally qualified
health center.
A "Dental Hygienist" is one who is legally licensed as such
by the State Board of Dentistry to perform those educational,
preventive, and therapeutic services and procedures that
licensed dental hygienists are educated to perform. Licensed
dentists may assign to dental hygienists intra-oral procedures
which the hygienists have been educated to perform and which
require their professional competence and skill but which do not
require the professional competence and skill of the dentist.
Such assignments shall be under the supervision of a licensed
dentist. Such performance of intra-oral procedures by licensed
dental hygienists shall be in the private office of a dentist or
public or private institution such as prescribed under section
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11.9(b). Dental hygienists certified as public health dental
hygiene practitioners may perform intra-oral procedures without
the assignment of a dentist pursuant to section 11.9. The
foregoing shall not be construed as authorizing the assignment
of diagnosing, treatment planning and writing prescriptions for
drugs or writing authorizations for restorative, prosthetic, or
orthodontic appliances. The board shall issue rules setting
forth the necessary education and defining the procedures that
may be performed by dental hygienists licensed under this act
including those procedures that may be performed under direct
and general supervision.
The word "board," as used in this act, means the State Board
of Dentistry.
"General Anesthesia" is a controlled state of
unconsciousness, including deep sedation, accompanied by the
partial or complete loss of protective reflexes which includes
the patient's inability to independently maintain an airway and
respond purposefully to physical stimulation or verbal command,
produced by a pharmacologic or nonpharmacologic method, or
combination thereof.
"Analgesia" means the diminution or elimination of pain in
the conscious patient.
"Conscious Sedation" means a minimally depressed level of
consciousness which retains the patient's ability to
independently and continuously maintain an airway and respond
appropriately to physical stimulation or verbal command,
produced by a pharmacologic or nonpharmacologic method, or
combination thereof.
"Expanded Function Dental Assistant" means an individual who
holds a current valid certification under this act to perform
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reversible intraoral procedures authorized by this act under the
direct supervision of a licensed dentist and under an assignment
of duties by a dentist, as defined in section 11.8. An expanded
function dental assistant may, under direct supervision, perform
those procedures specified in section 11.10 and other reversible
procedures not designated by this act to be performed by
licensed dentists or dental hygienists. For purposes of this
definition, "direct supervision" shall mean that a dentist is in
the dental office or treatment facility, personally diagnoses
the condition to be treated, personally authorizes the procedure
and remains in the dental office or treatment facility while the
procedure is being performed and, before dismissal of the
patient, personally evaluates the work performed.
"Foreign dental schools" means the dental schools which have
not been approved by the Commission on Accreditation of the
American Dental Association and which are located in countries
other than the United States or Canada.
"Public Health Dental Hygiene Practitioner" means a licensed
dental hygienist who may perform educational, preventive,
therapeutic and intra-oral procedures which the hygienist is
educated to perform and which require the hygienist's
professional competence and skill but which do not require the
professional competence and skill of a dentist without the
authorization, assignment or examination of a dentist, and who
is certified by the State Board of Dentistry as having satisfied
the requirements of section 11.9. Public health dental hygiene
practitioners may only engage in professional practice in the
practice sites enumerated in section 11.9(b).
"Restricted Faculty License" means a license granted to an
individual for the limited purpose of teaching, including
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clinical teaching, in a dental school or advanced dental
education program as a faculty member at an accredited dental
school in this Commonwealth.
"Volunteer License" means a license issued to qualified
individuals who retire from active practice and seek to provide
professional services as a volunteer in community-based clinics
without remuneration.]
Section 3. The act is amended by adding a section to read:
Section 11.12. Medical Loss Ratio.--(a) A dental benefits
plan or health care service plan that issues, sells, renews or
offers a specialized health care service plan contract covering
dental services shall file a medical loss ratio with the
Insurance Department of the Commonwealth that is organized by
market and product type and contains the same information
required in the 2013 Federal Medical Loss Ratio Annual Reporting
Form (CMS-10418).
(b) The medical loss ratio reporting year shall be for the
calendar year during which dental coverage is provided by the
plan. All terms used in the medical loss ratio annual report
shall have the same meaning as used in 42 U.S.C. ยง 300gg-18
(relating to bringing down the cost of health care coverage) and
45 CFR Pt. 158 (relating to issuer use of premium revenue:
reporting and rebate requirements).
(c) If data verification of the health care service plan's
representations in the medical loss ratio annual report is
deemed necessary, the Insurance Department shall provide the
health care service plan with a notification 30 days before the
commencement of the financial examination.
(d) The health care service plan shall have 30 days from the
date of notification to submit to the Insurance Department all
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requested data. The Insurance Commissioner may extend the time
for a health care service plan to comply with this subdivision
upon a finding of good cause.
(e) The Insurance Department shall make available to the
public the medical loss ratio report and other data provided to
the Insurance Department under this section.
(f) This section shall not apply to health care service
plans for health care services under Medical Assistance, the
Childrens' Health Insurance Plan or other State sponsored health
programs.
(g) The Insurance Department shall assess an administrative
penalty on a health insurer for a failure to comply with this
section.
(h) Nothing in this section shall be construed to guarantee
the rights of a health care practitioner to participate in a
health insurer network in this Commonwealth nor require a health
insurer to accept any willing health care provider to an
insurance network.
(i) The Insurance Department shall promulgate rules and
regulations to administer and enforce this section.
Section 4. This act shall take effect in 60 days.
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