PRIOR PRINTER'S NOS. 1860, 2166
PRINTER'S NO. 2323
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1585
Session of
2023
INTRODUCED BY FRANKEL, MADDEN, SANCHEZ, HILL-EVANS, McNEILL,
GUENST, DELLOSO, TAKAC, KHAN, DONAHUE, BOROWSKI AND GREEN,
JULY 18, 2023
AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
NOVEMBER 15, 2023
AN ACT
Providing for teledentistry; authorizing the regulation of
teledentistry by the board; 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.
"Board." The State Board of Dentistry.
"Children's Health Insurance Program." PROGRAM" OR "CHIP."
The children's health insurance program under Article XXIII-A of
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the act of May 17, 1921 (P.L.682, No.284), known as The
Insurance Company Law of 1921.
"Dental care provider." A dentist, dental hygienist or
public health dental hygiene practitioner who holds a valid
license or certificate under the Dental Law.
"Dental insurance policy." As follows:
(1) An insurance policy that pays or provides dental
expense benefits for covered dental services and is delivered
or issued for delivery by or through a dental insurer.
(2) The term includes coverage for dental benefits
issued, either on a stand-alone basis or integrated, or
otherwise incorporated into the terms and coverage of a
health benefits plan.
"Dental Law." The act of May 1, 1933 (P.L.216, No.76), known
as The Dental Law.
"Dental services." The general and usual services rendered
and care administered by a dental care provider.
"Health Information Technology for Economic and Clinical
Health Act." The Health Information Technology for Economic and
Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and
467-496).
"Health Insurance Portability and Accountability Act of
1996." The Health Insurance Portability and Accountability Act
of 1996 (Public Law 104-191, 110 Stat. 1936).
"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 Insurance Company Law of 1921, including section
630 and Article XXIV of that act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
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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.
"Medical assistance." Medical assistance as provided in
subarticle (f) of THE MEDICAL ASSISTANCE PROGRAM ESTABLISHED
UNDER Article IV of the act of June 13, 1967 (P.L.31, No.21),
known as the Human Services Code.
"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:
(1) is in the same group or health system;
(2) has access to the patient's prior dental records;
(3) holds a valid license under the Dental Law; and
(4) is in a position to coordinate care.
"MEDICAL ASSISTANCE OR CHILDREN'S HEALTH INSURANCE PROGRAM
MANAGED CARE PLAN" OR "MA OR CHIP MANAGED CARE PLAN." A HEALTH
CARE PLAN THAT USES A GATEKEEPER TO MANAGE THE UTILIZATION OF
HEALTH CARE SERVICES BY MEDICAL ASSISTANCE OR CHILDREN'S HEALTH
INSURANCE PROGRAM ENROLLEES AND INTEGRATES THE FINANCING AND
DELIVERY OF HEALTH CARE SERVICES.
"Participating network provider." A dental provider that has
entered a contractual or operating relationship with a health
insurer or medical assistance or Children's Health Insurance
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Program managed care plan to participate in one or more
designated networks of the health insurer or medical assistance
or Children's Health Insurance Program managed care plan TO
PARTICIPATE IN ONE OR MORE DESIGNATED NETWORKS OF THE HEALTH
INSURER to provide dental services under the terms of a health
insurance policy or an agreement with the Department of Human
Services.
"Remote patient monitoring." The collection of physiological
data from a patient in one location, which is transmitted
through electronic communication technology to a dental care
provider in a different location for use in care and related
support of the patient.
"Store-and-forward technology." As follows:
(1) Technology that stores and transmits or grants
access to a patient's health information for review by a
dental care provider who is at a different location. Health
information stored and transmitted using store-and-forward
technology may include radiographs, photographs, video or
digital impressions.
(2) The term does not include the storage, transmission
or use of electronic dental records without the concurrent
transmission of additional health information not already
present in the electronic dental records.
"Teledentistry." The delivery of dental services, including
patient education, provided through teledentistry technologies
to a patient by a dental care provider who is at a different
location.
"Teledentistry technologies." As follows:
(1) Electronic information and telecommunications
technology, including interactive audio and video, remote
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patient monitoring or store-and-forward technology, that
meets the requirements of the following:
(i) The Health Insurance Portability and
Accountability Act of 1996.
(ii) The Health Information Technology for Economic
and Clinical Health Act.
(iii) Other applicable Federal or State law.
(2) The term does not include the use of:
(i) Audio-only medium, voicemail, facsimile, email,
instant messaging, text messaging or online questionnaire
or any combination thereof.
(ii) A telephone call, except as provided under
section 5(a)(3).
Section 3. Regulation of teledentistry by board.
(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 board.
(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
board under the Dental Law.
(b) Regulations.--Within 24 months of the effective date of
this subsection, the board shall 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 board. The following apply:
(1) The standard of care applicable to an in-person
encounter shall apply to a teledentistry encounter.
(2) The regulations shall:
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(i) Consider model policies and clinical guidelines
for the appropriate use of teledentistry technologies,
including care coordination, preventive care and
emergency care.
(ii) Include patient privacy and data security
standards that are in compliance with:
(A) The Health Insurance Portability and
Accountability Act of 1996.
(B) The Health Information Technology for
Economic and Clinical Health Act.
(C) Other applicable Federal or State law.
(c) Temporary regulations.--To facilitate the prompt
implementation of this act, within 270 days of the effective
date of this subsection, the board shall transmit notice of
temporary regulations regarding implementation of this act to
the Legislative Reference Bureau for publication in the next
available issue of the Pennsylvania Bulletin. The following
apply:
(1) The temporary regulations shall not be subject to:
(i) Section 612 of the act of April 9, 1929
(P.L.177, No.175), known as The Administrative Code of
1929.
(ii) 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.
(iii) Sections 204(b) and 301(10) of the act of
October 15, 1980 (P.L.950, No.164), known as the
Commonwealth Attorneys Act.
(iv) The act of June 25, 1982 (P.L.633, No.181),
known as the Regulatory Review Act.
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(2) The 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.
(d) Construction.--The provisions of this act shall be in
full force and effect even if the board 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 board. Failure to hold a valid
license shall subject the dental care provider to discipline by
the board for unlicensed practice under the Dental Law.
Section 5. Evaluation and treatment.
(a) Requirements.--Except as provided under subsection (b),
a dental care provider who provides teledentistry to an
individual located in this Commonwealth shall:
(1) For a teledentistry encounter in which the dental
care provider does not have an established provider-patient
relationship:
(i) verify the state location and identity of the
individual receiving dental care by requesting that the
patient provide at least two patient identifiers, such as
name and date of birth; and
(ii) disclose the dental care provider's identity,
geographic location, license number and dental specialty
or applicable credentials.
(2) Obtain informed consent regarding the use of
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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) Perform an appropriate clinical examination or
assessment using teledentistry technologies. The following
apply:
(i) 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 appropriate
legal standard of care.
(ii) If 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, including care coordination or referrals,
unless inconsistent with the legal standard of care.
(5) Create and maintain an electronic dental record or
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update an existing electronic dental record for the patient
within 24 hours. An electronic dental record shall be
maintained in accordance with electronic medical records
privacy rules under the Health Insurance Portability and
Accountability Act of 1996 and other applicable Federal or
State laws.
(6) Provide a visit summary to the individual.
(7) Have an emergency action plan in place for dental
emergencies and referrals or care coordination.
(b) Limitations on treatment.--Teledentistry services shall
be subject to the same legal standard of care applicable to an
in-person encounter.
Section 6. Insurance coverage of teledentistry.
(a) Insurance coverage and reimbursement.--
(1) A dental insurance policy utilizing a provider
network that is issued, delivered, executed or renewed in
this Commonwealth after the effective date of this section
shall provide coverage for both medically necessary and
preventive 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 service from coverage solely
because the service is provided through teledentistry.
(2) Subject to paragraph (1), a health insurer shall
reimburse a participating network provider for covered dental
services delivered through teledentistry and pursuant to a
health insurance policy in accordance with the terms and
conditions of the participation agreement as negotiated
between the health insurer and the participating network
provider. A participation agreement that includes
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reimbursement for covered dental services delivered through
teledentistry may not prohibit reimbursement solely because a
dental service is provided by teledentistry. Reimbursement
may not be conditioned upon the use of an exclusive
proprietary teledentistry technology or teledentistry vendor.
(b) Applicability.--
(1) Subsection (a) shall not apply if the teledentistry-
enabling device, technology or service fails to comply with
applicable law or regulatory guidance.
(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.
(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.
(3) Require an insurer to reimburse a participating
network provider if the provision of the dental service
through teledentistry would be inconsistent with the legal
standard of care.
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Section 7. Medical assistance 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.--
(1) To perform teledentistry services, a dental care
provider must use technology platforms that are compliant
with the Health Insurance Portability and Accountability Act
of 1996.
(2) Teledentistry services must be consistent with the
legal standard of care.
Section 8. Children's Health Insurance Program reimbursement.
(a) Children's Health Insurance Program payment.--Children's
Health Insurance Program 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.--
(1) To perform teledentistry services, a dental care
provider must use technology platforms that are compliant
with the Health Insurance Portability and Accountability Act
of 1996.
(2) Teledentistry services must be consistent with the
legal standard of care.
SECTION 7. MEDICAL ASSISTANCE AND CHILDREN'S HEALTH INSURANCE
PROGRAM COVERAGE.
(A) GENERAL RULE.--MEDICAL ASSISTANCE AND CHIP PAYMENTS
SHALL BE MADE FOR MEDICALLY NECESSARY SERVICES IF ALL OF THE
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FOLLOWING APPLY:
(1) IF THE SERVICES THROUGH TELEDENTISTRY WOULD BE
COVERED THROUGH AN IN-PERSON ENCOUNTER.
(2) A SERVICE THROUGH TELEDENTISTRY IS CONSISTENT WITH
FEDERAL LAW, THE LAWS OF THIS COMMONWEALTH AND APPLICABLE
REGULATIONS AND GUIDANCE.
(3) FEDERAL APPROVAL, IF NECESSARY, HAS BEEN RECEIVED BY
THE DEPARTMENT OF HUMAN SERVICES.
(B) APPLICABILITY.--
(1) SUBSECTION (A) SHALL NOT APPLY IF THE TELEDENTISTRY
TECHNOLOGY FAILS TO COMPLY WITH APPLICABLE STATUTE,
REGULATIONS AND DEPARTMENTAL GUIDANCE.
(2) NOTHING IN THIS BILL SHALL REQUIRE MEDICAL
ASSISTANCE OR CHIP TO PAY FOR A SERVICE UTILIZING STORE-AND-
FORWARD TECHNOLOGY OR REMOTE PATIENT MONITORING.
(C) CONSTRUCTION.--THIS SECTION MAY NOT BE CONSTRUED TO:
(1) PROHIBIT A MA OR CHIP MANAGED CARE PLAN FROM MAKING
PAYMENTS ON BEHALF OF ENROLLEES TO OTHER DENTAL CARE
PROVIDERS FOR A COVERED SERVICE PROVIDED.
(2) REQUIRE MEDICAL ASSISTANCE OR CHIP TO PAY FOR A
SERVICE UNDER THIS ACT IF THE DELIVERY OF THE SERVICE THROUGH
TELEDENTISTRY WOULD BE INCONSISTENT WITH THE NECESSARY
STANDARD OF CARE.
Section 9 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) (2) The remainder of this act shall take effect
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immediately.
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