PRINTER'S NO. 4048
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2645
Session of
2020
INTRODUCED BY MURT, SCHLOSSBERG, FREEMAN, CALTAGIRONE, FRANKEL,
CIRESI, SCHWEYER AND YOUNGBLOOD, JUNE 29, 2020
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, JUNE 29, 2020
AN ACT
Relating to teledentistry; authorizing the regulation of
teledentistry by the State Board of Dentistry; and providing
for insurance coverage of teledentistry.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Teledentistry
Act.
Section 2. 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:
"Audio-only medium." A prerecorded audio presentation or
recording.
"Dental care provider." A dentist or dental hygienist who
holds a valid license under The Dental Law.
"Dental insurance policy." An individual or group health
insurance policy, contract or plan that provides coverage for
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dental services provided by a dental care provider that is
offered by a health insurer.
"Dental services." The general and usual services rendered
and care administered by doctors of dental surgery, as specified
in The Dental Law.
"Emergency dental condition." A dental condition manifesting
itself by acute symptoms of sufficient severity, including
severe pain, that the absence of immediate dental attention
could reasonably be expected to result in placing the dental
health of the individual in serious jeopardy.
"Health insurer." An entity that holds a valid license by
the insurance department to issue a dental insurance policy and
is governed under any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Interactive audio and video." Real-time two-way or
multiple-way communication between a dental care provider and a
patient.
"On-call or cross-coverage services." The provision of
teledentistry by a dental care provider designated by another
dental care provider with a provider-patient relationship to
deliver dental services on a temporary basis so long as the
designated dental care provider is in the same group or health
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system, has access to the patient's prior dental records, holds
a valid license under The Dental Law, and is in a position to
coordinate care.
"Out-of-State dental care provider." A dental care provider
providing a teledentistry service that holds a valid license,
certificate or registration to provide dental services in
another jurisdiction and is:
(1) discharging official duties in the armed forces of
the United States, the United States Public Health Service or
the United States Department of Veterans Affairs;
(2) providing teledentistry services to a patient
through a federally operated facility;
(3) providing teledentistry services in response to an
emergency dental condition, if the care for the patient is
referred to an appropriate dental care provider in this
Commonwealth as promptly as possible under the circumstances;
(4) providing provider-to-provider consultation
services; or
(5) providing services which would otherwise be exempt
from the licensure requirements under The Dental Law.
"Provider-to-provider consultation." The act of seeking
advice and recommendations from another dental care provider for
dental services that may benefit the patient of the initiating
dental care provider.
"Store-and-forward." Technology that stores and transmits or
grants access to a patient's clinical information for review by
a dental care provider who is at a different location. The term
does not include the storage, transmission or use of electronic
dental records without the concurrent transmission of additional
clinical information not already present in the electronic
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dental records.
"Teledentistry." The delivery of dental care services
provided through teledentistry technologies to a patient by a
dental care provider who is at a different location. The term
does not include a provider-to-provider consultation.
"Teledentistry technologies." As follows:
(1) Electronic information and telecommunications
technology, including, but not limited to, interactive audio
and video, remote patient monitoring or store-and-forward,
that meets the requirements of applicable Federal and State
laws.
(2) The term does not include the use of:
(i) Audio-only medium, voicemail, facsimile, e-mail,
instant messaging, text messaging or online questionnaire
or any combination thereof.
(ii) A telephone call, except as provided under
section 5(a)(3).
"The Dental Law." The act of May 1, 1933 (P.L.216, No.76),
known as The Dental Law.
Section 3. Regulation of teledentistry by State Board of
Dentistry.
(a) Requirements.--
(1) A dental care provider shall be authorized to
practice teledentistry in accordance with this act and the
corresponding regulations promulgated by the State Board of
Dentistry.
(2) A dental care provider who engages in teledentistry
in a manner that does not comply with the standards of care
or rules of practice shall be subject to discipline by the
State Board of Dentistry under The Dental Law.
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(b) Regulations.--The State Board of Dentistry shall, within
24 months of the effective date of this section, promulgate
final regulations that are consistent with this act to provide
for and regulate teledentistry within the scope of practice and
standard of care regulated by the State Board of Dentistry. The
regulations shall not establish a separate standard of care for
teledentistry. The standard of care applicable to an in-person
encounter shall apply to a teledentistry encounter. The
regulations shall:
(1) Consider model policies and clinical guidelines for
the appropriate use of teledentistry technologies.
(2) Include patient privacy and data security standards
that are in compliance with applicable Federal and State
laws.
(c) Temporary regulations.--In order to facilitate the
prompt implementation of this act, the State Board of Dentistry
shall transmit notice of temporary regulations regarding
implementation of this act to the Legislative Reference Bureau
for publication in the Pennsylvania Bulletin within 120 days of
the effective date of this section. Temporary regulations are
not subject to:
(1) Section 612 of the act of April 9, 1929 (P.L.177,
No.175), known as The Administrative Code of 1929.
(2) Sections 201, 202, 203, 204 and 205 of the act of
July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(3) Sections 204(b) and 301(10) of the act of October
15, 1980 (P.L.950, No.164), known as the Commonwealth
Attorneys Act.
(4) The act of June 25, 1982 (P.L.633, No.181), known as
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the Regulatory Review Act.
(d) Expiration.--Temporary regulations shall expire no later
than 24 months following publication of temporary regulations.
Regulations adopted after this period shall be promulgated as
provided by law.
(e) Construction.--The provisions of this act shall be in
full force and effect even if the State Board of Dentistry has
not yet published temporary regulations or implemented the
regulations required under this section.
Section 4. Compliance.
A dental care provider providing teledentistry services to an
individual located within this Commonwealth shall comply with
all applicable Federal and State laws and regulations, and shall
hold a valid license by the State Board of Dentistry. Failure to
hold a valid license shall subject the dental care provider to
discipline by the State Board of Dentistry for unlicensed
practice under The Dental Law.
Section 5. Evaluation and treatment.
(a) Requirements.--Except as provided under subsection (c),
a dental care provider who provides teledentistry to an
individual located in this Commonwealth shall comply with the
following:
(1) For a teledentistry encounter in which the provider
does not have an established provider-patient relationship,
the dental care provider shall:
(i) verify the location and identity of the
individual receiving dental care; and
(ii) disclose the dental care provider's identity,
geographic location and dental specialty or applicable
credentials.
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(2) Obtain informed consent regarding the use of
teledentistry technologies from the individual or other
person acting in a dental care decision-making capacity for
the individual. The individual or other person acting in a
dental care decision-making capacity, including the parent or
legal guardian of a child in accordance with the act of
February 13, 1970 (P.L.19, No.10), entitled "An act enabling
certain minors to consent to medical, dental and health
services, declaring consent unnecessary under certain
circumstances," has the right to choose the form of service
delivery, which includes the right to refuse teledentistry
services without jeopardizing the individual's access to
other available services.
(3) Provide an appropriate examination or assessment
using teledentistry technologies. The dental care provider
may utilize interactive audio without the requirement of
interactive video if it is used in conjunction with store-
and-forward technology and, after access and review of the
patient's medical records, the dental care provider
determines that the dental care provider is able to meet the
same standards of care as if the dental care services were
provided in person. When the dental care provider utilizes
interactive audio without interactive video, the dental care
provider shall inform the patient that the patient has the
option to request interactive audio and video.
(4) Establish a diagnosis and treatment plan or execute
a treatment plan.
(5) Create and maintain an electronic dental record or
update an existing electronic dental record for the patient
within 24 hours. An electronic dental record shall be
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maintained in accordance with applicable Federal or State
laws.
(6) Provide a visit summary to the individual if
requested.
(7) Have an emergency action plan in place for dental
emergencies and referrals.
(8) The standard of care applicable to an in-person
encounter shall apply to a teledentistry encounter. If the
use of teledentistry would be inconsistent with the standard
of care, the dental care provider shall direct the patient to
seek in-person care.
(b) Applicability.--
(1) Subsection (a)(1) shall not apply to on-call or
cross-coverage services.
(2) Subsection (a)(1) and (2) shall not apply to an
emergency dental condition.
(c) Limitations on treatment.--Teledentistry services or
technologies shall not be permitted to be utilized or employed
for the delivery or administration of any dental care services
that are required to be delivered or administered in a dentist's
office.
Section 6. Insurance coverage of teledentistry.
(a) Insurance coverage and reimbursement.--
(1) A dental insurance policy issued, delivered,
executed or renewed in this Commonwealth after the effective
date of this section shall provide coverage for medically
necessary teledentistry delivered by a dental care provider
who provides a covered service via teledentistry consistent
with the health insurer's dental policies. A dental insurance
policy may not exclude a dental care service for coverage
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solely because the service is provided through teledentistry.
(2) Subject to paragraph (1), a health insurer shall
reimburse a dental care provider for both in-person and
teledentistry services in accordance with the terms and
conditions of the participation agreement between the health
insurer and the dental care provider. Reimbursement shall not
be conditioned upon the use of an exclusive teledentistry
platform or teledentistry vendor.
(3) Payment for a covered service provided via
teledentistry by any dental care provider shall be
established between the dental care provider and health
insurer.
(b) Applicability.--This section shall apply as follows:
(1) Subsection (a)(1) and (2) shall not apply if the
teledentistry service is facilitated via a dental device or
other technology that provides clinical data or information,
excluding existing information in an electronic dental
records system, other than that independently provided
through interactive audio and video with, or store-and-
forward imaging provided by, the patient.
(2) For a dental insurance policy for which either rates
or forms are required to be filed with the Federal Government
or the insurance department, this section shall apply to a
policy for which a form or rate is first filed on or after
180 days after the effective date of this section.
(3) For a dental insurance policy for which neither
rates nor forms are required to be filed with the Federal
Government or the insurance department, this section shall
apply to a policy issued or renewed on or after 180 days
after the effective date of this section.
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(c) Construction.--Nothing under this section shall be
construed to:
(1) Prohibit a health insurer from reimbursing other
dental providers for covered services provided via
teledentistry.
(2) Require a health insurer to reimburse an out-of-
network dental care provider for teledentistry.
Section 7. Medicaid program reimbursement.
(a) Medical assistance payment.--Medical assistance payments
shall be made on behalf of eligible individuals for
teledentistry, consistent with Federal law, as specified under
this act if the service would be covered through an in-person
encounter.
(b) Applicability.--Subsection (a) does not apply if:
(1) the teledentistry-enabling device, technology or
service fails to comply with applicable law and regulatory
guidance regarding the secure transmission and maintenance of
patient information; or
(2) the provision of the service using teledentistry
would be inconsistent with the standard of care.
Section 8. Effective date.
This act shall take effect as follows:
(1) Section 6 shall take effect upon publication in the
Pennsylvania Bulletin of the temporary regulations required
in section 3(c).
(2) Section 7 shall take effect in 90 days.
(3) The remainder of this act shall take effect
immediately.
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