phoneHuman Resources Hotline

Call free with all of your burning HR questions – SDDS Member benefit!

1-800-399-5331

SDDS Design Department

The SDDS Design Department is open and ready for your business. As a member benefit, our Design Department is ready to help our SDDS Members. This member benefit is something that we think will be a great opportunity for our SDDS members only. We are excited to share our talents with you – hope you call us! Click here for more information.

Job Bank

The SDDS Job Bank is a service offered only to SDDS Members. It provides a forum for job-seekers to reach other Society members who may be looking for dentists to round out their practice, and vice versa. If you are a job seeker, associate seeker, selling or buying a practice, contact SDDS at (916) 446-1227 and cash into the SDDS Job Bank!
Click here to be listed in the Job Bank

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Name Phone / Fax Email Dental School Location Specialty
Ashkan Alizadeh, DDS P: 916.487.7148 F: 916.487.1468 alizadehdds[at]gmail.com NYU (2003) Sacramento, (F/T)(P/T) General
Darryl Azouz, DDS P: 916.630.1084
F: 916.303.4310
serenitydental[at]yahoo.com USC (2000) Rocklin, (F/T) General
Marjoorie Castro, DDS P: 916.538.6900 drcastro[at]sacramentodentistry.com Pontificia Universidad Javeriana (1989) Sacramento(F/T) General
George Chen, DDS P: 916.983.6051
F: 916.983.6201
drchen[at]folsomdentist.com Loma Linda 1991) Folsom (Part) General
Gary Clusserath, DMD P: 425.444.0500
F: 916.773.4348
gcluss[at]gmail.com OHSU (1987) Roseville, Citrus Heights (3-4 days/week) General/Endo/OMS
Raul Contreras, DMD P: 530.885.6559 F: 530.885.4142 raulcontrerasdmd[at]gmail.com Temple University (2011) Auburn (P/T 2-4 days per week) General
Paul Denzler, DDS P: 916.622.5246 denzler[at]mylincolndentist.com UCLA (2000) Lincoln (P/T) General
Eloisa Espiritu, DDS P: 916.204.2819 eloisadds[at]yahoo.com UCSF(2002) Lincoln(F/T & P/T) General
Timothy Herman, DDS P: 916.408.5557
F: 916.409.5557
timhermandds[at]gmail.com UCSF (1988) Lincoln (F/T & P/T) General
Ralph Isola, DDS/> P: 916.737.1155
F: 916.737.0508
isoladds[at]surewest.net UOP (1986) Sacrament (P/T & P/T) General
KidsCare Dental Group and Orthodontics P: 916.678.3565
F: 916.469.2293
cschreiber[at]kidscaredental.com, jwidmann[at]kidscaredental.com Roseville (F/T)<(/td>

Peds
KidsCare Dental Group and Orthodontics P: 916.678.3565
F: 916.469.2293
cschreiber[at]kidscaredental.com, jwidmann[at]kidscaredental.com Rancho Cordova, (F/T) Ortho
Hung Le, DDS P: 916.691.1141 ledentalresumes[at]gmail.com NYU (2001) South Sacramento, Stockton (P/T, F/T) General
Thomas Ludlow, DDS P: 916.983.6767 F: 916.983.8668 folsomdds[at]hotmail.com UCSF (2000) Folsom AND Modesto (P/T, F/T) General
Thomas McKelvey, DDS P: 209.639.9851 hcmckelvey[at]gmail.com LLUSD(1986) Twain Harte (F/T) GP
Kayla Nguyen, DDS P: 916.784.1144
F: 916.786.2409
kaylanguyen75[at]hotmail.com UCSF (2002) Roseville/Lincoln (F/T& P/T) General
David Park, DDS P: 310.403.1117 davidparkdds[at]gmail.com UCLA 2004 (F/T) General
Mai-Ly Ramirez, DDS P: 916.780.3000
F: 916.780.3030
fountainsdentist[at]gmail.com UCSF(1999) Roseville (P/T) GP
Hetal Rana, DDS P: 916.774-4499
F: 916.774.4767
info[at]bluehilldental.net Gurjavat Univ,India(1998) Roseville (P/T) GP
David Roholt, DDS P: 530.885.5696

dhroholtdds[at]gmail.com Auburn (F/T) GP
Sean Roth, DDS P: 916.812.4775 sroth[at]hotmail.com UOP(2001) Folsom (P/T) GP
Sang Tran, DDS P: 916.320.1354 drtran[at]varsitydentistry.com UOP(2000) Davis (P/T) GP
Steven Tsuchida, DDS P: 916.342.5193
F: 916.989.3775
surfrider7[at]hotmail.com UOP (2001) Elk Grove (F/T, P/T) O/S
Jerard Wilson, DDS P: 916.663.5555 yourdentist[at]rocklindentalcenter.com UCLA (1970) Rocklin (P/T) General
Raj Zanzi, DDS P: 916.705.0211 smile_dentist[at]yahoo.com Tufts Univ(1999) Roseville P/T Fri & 1 Sat/ month General

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Name Phone Email Dental School Schedule Specialty
Russell Anders, DDS 530.644.3438 ra95709[at]gmail.com UOP (1965) P/T (fill in/Locum Tenens) General
Behdad Javdan, DDS 310.403.3479 bjavdan2013[at]gmail.com UCSF (2013) P/T, F/T Perio
Gary Krupa, DDS 530.867.2500 88gandl[at]gmail.com Loyola Univ. of Chicago(1979) F/T & (Locum Tenans) GP
Patricia Murphy, DDS 858.342.2778 patmurphy[at]cox.net UOP(1992) F/T General
Steve Murphy, DMD 412.855.9914 murphy.steve[at]hotmail.com University of Connecticut (2001)
Boston University (2007)
P/T, F/T Endo
Ronald Rott, DDS 916.835.3504 ronaldrott[at]gmail.com UCSF / University of Washington (1967) P/T Perio
Steve Saffold, DDS 916.442.6566 spsaff[at]att.net Georgetown (1977) EMERGENCY Fill In Only GP
Harpreet Tiwana, DDS 708.990.4806 htiwana39[at]gmail.com NYU(20021977) (P/T)/

GP

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Name Phone Email School Schedule Specialty
Janis DuFort, RDH 916.2028766 janis8766[at]gmail.com F/T RDH

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Name Phone Email Dental School Location Specialty
Behdad Javdan, DDS 310.403.3479 bjavdan2013[at]gmail.com UCSF (2013) Perio
Scott Snyder, DDS 916.216.3929 drsnyderdds[at]sbcglobal.net UCS (2000) General

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Name Phone Email Dental School Location Specialty
Paul Raskin, DDS 916.971.6700 praskin[at]neubite.com University of Detroit (1964) Sacramento General
Name not disclosed elkgrovedental96@gmail.com Elk Grove General

You Should Know

Reprinted with permission from the CDA Practice Support.

CDA members may now renew their annual membership dues online.

With membership in organized dentistry, dentists ensure their voices and the needs of the profession are represented on every level.

Members have the option of renewing their dues in full or enrolling in the electronic dues payment program. The EDP program allows for payments in equal monthly installments that will be deducted automatically from a designated checking account.

CDA provides education, practice support, protection and a stronger voice in government through its legislative advocacy work. Members also enjoy these benefits:

Waived $890 registration fee for CDA Presents, the twice-yearly convention that takes place in Anaheim in the spring and San Francisco in the fall. At the convention, members can access free continuing education units, stay current on the latest dental technology trends and receive discounted pricing on equipment and supplies. New dentists will find recommended course listings to help guide their experience.
Dedicated team of CDA professionals whose sole purpose is to advocate for the dental profession and for patients. In 2016, CDA sponsored a new law that makes the dental board’s student loan repayment program less restrictive and successfully advocated for lawmakers to remove dentists from surprise billing legislation. In recent years, CDA has also sponsored new laws that improve dentists’ and patients’ rights when working with their dental benefits and increased Denti-Cal funding through additional federal dollars and the reversal of a 10-percent reimbursement rate cut.
Access to CDA Practice Support, which offers nearly 500 valuable resources to help dentists better manage the business side of dentistry. In 2016, CDA Practice Support launched “Are you in Compliance?,” a new resource that lists laws and regulations, organized by deadline date and year, that dental practices must comply with. Other Practice Support resources include customizable sample letters, forms, checklists, FAQs and agreements. The Sample Employee Manual, Injury and Illness Prevention Plan, New Patient Forms, Guidelines for Informed Consent, Hazard Communication Plan, and Required Postings are among the most used resources.
Unlimited phone support, also through CDA Practice Support, with analysts specializing in dental benefit plans, regulatory compliance, employment practice and practice management. The analysts are available to answer everyday questions dentists have. Dentists may also use the “Ask an Expert” feature to receive a response from an expert within one business day.
Substantial multipolicy discounts with the TDIC Optimum Bundle. Professional Liability, Commercial Property and Workers’ Compensation coverage can be bundled for savings. In addition, CDA member dentists can benefit from comprehensive disability coverage at a competitive price through the MetLife association policy.
Career assistance, a Risk Management Advice Line, Peer Review and much more.
Renew CDA membership at cda.org/member.

Reprinted with permission from the CDA Practice Support.

A federal judge in Texas on Tuesday, Nov. 22, issued a nationwide injunction blocking implementation of the U.S. Department of Labor’s Fair Labor Standards Act (FLSA) rule concerning overtime pay for certain employees who are currently classified as exempt from overtime. The injunction follows lawsuits filed by multiple states and business groups.

Under the rule, which was set to take effect Dec. 1, all employers would be required to pay a minimum salary of $913 per week, or $47,476 per year in order for an employee to be classified as exempt. Employers in California would need to pay close attention to and adjust salaries over the next several years in consideration of the annual state minimum wage increases due to begin Jan. 1, 2017.

CDA reported on the new FLSA rule in the December CDA Update, noting that the rule would take effect Dec. 1. With the injunction issued, employers are not required to comply with the rule by Dec. 1. CDA will keep members updated on the status of the injunction and court case at cda.org and in the CDA Update.

Questions about the FLSA rule and the injunction may be directed to CDA Practice Support at 800.232.7645.

Reprinted with permission from the CDA Practice Support.

Legislation signed in September by Gov. Brown resolves a longstanding conflict concerning whether health care providers’ use of online marketing companies to advertise health care services constitutes fee splitting or payment for referrals, both of which are prohibited under state law.
Assembly Bill 2744 (Gordon, D-Menlo Park) permits health care providers to advertise online via vouchers for specific services through Groupon, Living Social and other similarly structured social coupon companies. Under the new law, the sale of such a voucher for health care services is not considered a payment for referral of patients as long as the third-party advertiser does not recommend, endorse or select the health care provider. Payment for referral of patients is a violation of California’s Business and Professions code, Section 650, as well as CDA’s code of ethics.
Groupon and its direct competitors operate by contracting with businesses, including health care providers, to promote discounted products and services to potential customers. In order to take advantage of the discounted service, the customer must provide advance payment directly to the online company, which typically deducts a percentage as its contracted fee and remits the balance of the payment to the business.
Questions had been raised in California and other states about the use of these online marketing companies because, unlike with traditional advertising where a flat fee is paid irrespective of how successful the advertisement is, the third party (or online marketing company) receives a share of the purchase price of each voucher sold. CDA’s previous guidance urged dentists to avoid using these online coupon programs, or to negotiate a flat-fee structure to avoid engaging in what has been construed as the noncompliant “per-referral fee.”
CDA worked with the author’s office to ensure that any gray area surrounding payment for referral of patients and fee splitting was eliminated for dentists.
Three amendments CDA requested were folded into AB 2744, allowing CDA to move from an “oppose unless amended” to a neutral position on the Groupon-sponsored bill. These amendments protect a dentist’s authority to diagnose and better inform consumers. Specifically, they require that offers of discounted health care services through social coupons include:
Disclosure of the discounted price of the advertised service in comparison with the actual cost of the service. Furthermore, the bill states, “The fee paid to the third-party advertiser must be commensurate with the services provided by the third-party advertiser.”
Disclosure that not all purchasers may be eligible for the advertised health care service and that “a consultation is required” to determine the patient’s appropriate care.
Disclosure that if the purchaser is not a candidate for the purchased health care service, or does not claim the service for any reason, the purchaser will receive a refund of the full purchase price as determined by the terms of the advertising service agreement.
To align the bill with covered benefits required under the Affordable Care Act, “basic health care services” and “essential health benefits” are excluded from services that may be offered through online advertising vouchers. Therefore, under the new law, advertising for cosmetic and adult dental services is allowable but advertising for pediatric dental services is not.
While the new law exempts marketing some health care services through social couponing from the restrictions imposed by Section 650, it maintains the ban on payment for referrals and fee splitting in all other circumstances.
The bill goes into effect Jan. 1, 2017.
For resources on compliance with this new law, please visit cda.org/practicesupport.

Reprinted with permission from the ADA.

You may know the Centers for Disease Control and Prevention (CDC) publishes a monthly “Vital Signs” report. This month’s report focused on dental sealants, and the CDC recommends sealants because:
• They are a quick, easy, and painless way to prevent most of the cavities children get in the permanent back teeth, where 9 in 10 cavities occur.
• Once applied, sealants protect against 80% of cavities for 2 years and continue to protect against 50% of cavities for up to 4 years.
• Sealants can eliminate the need for expensive and invasive treatments like dental fillings or crowns.
• Applying sealants in schools for about 7 million low-income children who don’t have them could save up to $300 million in dental treatment costs.
Read more about the CDC report in ADA News.
The ADA agrees that dental sealants are safe and effective. In fact, the ADA Council on Scientific Affairs and the American Academy of Pediatric Dentistry (AAPD) recently convened a panel that developed a clinical practice guideline on sealants that was based on a systematic review of existing literature. The guidelines were released in August, and we encourage all members to review them.
Additionally, consumer-friendly information about sealants, including a video and infographics, are available at MouthHealthy.org. Dentists may wish to share this content with their patients.

Reprinted with permission from the CDA.

Under a new law, all applicants licensed by the Dental Board of California are required to submit their email address to the board effective July 1. The board plans to contact licensed dentists annually to confirm that their email addresses on file are correct.
Licensees who have not already done so, or whose email address has since changed, should submit their email address to the board by emailing and including their name, license number and email address using the subject line “Electronic Mail Address Requirement.”
As the Department of Consumer Affairs’ new licensing and enforcement system, known as BreEZe, gains some additional features, licensees will be able to quickly update their email addresses and more online. Email addresses will be kept confidentially by the board and will not be subject to public disclosure.

Reprinted with permission from the CEA.

The USCIS announced that an updated Form I-9 has been approved. The current form had a revision date of 03/08/2013 N and expired in March this year, but is acceptable for continued use. However, on August 25, 2016, the Office of Management and Budget (OMB) approved a revised Form I-9, Employment Eligibility Verification. USCIS must publish a revised form by November 22, 2016. Employers may continue using the current version of Form I-9 until January 21, 2017. After January 21, 2017, all previous versions of Form I-9 will be invalid.
Make sure you are always using the most current, acceptable version of the Form I-9. Even if you self audit and find an employee does not have an I-9 on file, use the current version (not the version based on their date of hire) to verify the employee’s employment. For tips on self-audits and other Form I-9 issues, the “Handbook for Employers” https://www.uscis.gov/sites/default/files/files/form/m-274.pdf issued by the USCIS is extremely helpful.
The USCIS also offers free webinars on a regular basis with a live question and answer opportunity as well as other learning resources on its web site https://www.uscis.gov/i-9-central/learning-resources.
Of course, CEA has information on our web site https://www.employers.org/i-9-forms and is here to answer your questions as well.

Reprinted with permission from the ADA.

The ADA News (10/31, Burger) reports a new resolution passed by the ADA House of Delegates amended the ADA Principles of Ethics and Code of Professional Conduct to permit “dentists to announce as specialists recognized in their jurisdictions even if it’s not one of the nine dental specialties recognized by the Association.” Resolution 65H-2016 also amended the Code to specify that “a dentist holding specialty degrees should be permitted to practice to the full scope of the dental licenses that they hold so long as they maintain adequate expertise in the specialty.” Dr. Michael Halasz, Ohio-based general practitioner and chair of the Council on Ethics, Bylaws and Judicial Affairs, said, “It’s a fairly significant change.” Dr. Halasz added, “The bottom line is that it keeps dentists in line with the Code of Ethics, which puts patients first.” The amendments come as states, compelled by court decisions, are beginning to recognize specialties beyond the nine dental specialties recognized by the ADA. “We’re trying to stay ahead of the issue,” said Dr. Halasz.

Reprinted with permission from the CDA Practice Support.

Dispose of out-of-date, damaged or otherwise unusable or unwanted controlled substances, including samples, by transferring them to an entity that is authorized to receive such materials. These entities are referred to as “reverse distributors.” Contact your local DEA field office (deadiversion.usdoj.gov/offices_n_dirs/index.html) for a list of authorized reverse distributors. Mail-back programs are also available. Schedule II controlled substances should be transferred via the DEA Form 222, while Schedule III, IV and V compounds may be transferred via invoice. Maintain copies of the records documenting the transfer and disposal of controlled substances for two years. Prescribers should encourage patients to properly dispose of their unused or expired controlled substances through their local pharmacy or take-back event sponsored by local law enforcement. The DEA amended regulations in September 2014 to allow retail pharmacies, hospitals and clinics with pharmacies to collect the drugs from the ultimate users and to place collection containers at long-term care facilities.

Reprinted with permission from the CDA Practice Support.

The theft or loss of controlled substances from a prescriber’s premises must be reported to local law enforcement and to the DEA. Report the theft or loss to the DEA using form 106, available at deadiversion.usdoj.gov/21cfr_reports/theft/ index.html. Secured prescription forms that are lost or stolen must be reported to local law enforcement and the state Department of Justice CURES/PDMP no later than three days after the discovery of the loss or theft. Go to oag.ca.gov/cures-pdmp#lost to report the loss or theft. Prescribers registered to access the CURES database can use the database to electronically report the loss or theft; police report number is required.

For questions concerning how to report lost or stolen prescription pads or forms, contact the Security Prescription Printer Program at SecurityPrinter@doj.ca.gov.

Reprinted with permission from the CDA.

The Centers for Medicare and Medicaid Services (CMS) will be extending to Jan. 1, 2016, the effective date by which dentists must have either enrolled or officially opted out of Medicare in order for prescriptions they write to be covered by Medicare Part D. This proposed rule would also require Part D plans to cover a “provisional supply” of up to 90 days of a medication prescribed by a doctor who has not enrolled or opted out. A Part D plan must notify the beneficiary in writing within three business days that the medication is being covered on a provisional basis because of the prescriber’s current Medicare status. Part D plans must also make reasonable efforts to notify the prescriber. After covering the provisional supply and providing the notice to the beneficiary, the Part D plan will be required to reject future claims for the same medication for that beneficiary if the prescription is from the same prescriber.

Note that for a dentist to meet the Jan. 1, 2016, effective date, they must submit their application at least 90 days before this date to allow sufficient time for processing.

Medicare Advantage
“Opting out” is not an option for any provider who treats patients in a Medicare Advantage plan and wishes for their patients to receive the benefit from the MA plan. This is true whether the provider is in network for the MA plan or not (for PPO-type MA plans). The MA organization is required to check the opt-out list on a regular basis. Remember if a dentist has already opted out, they can reverse their decision within 90 days. Enrolling either using the 855i (full enrollment) or the 855o (ordering and referring provider) are valid options for a dentist treating patients with an MA plan. If a non-contracted dentist enrolls in Medicare using the 855i this does not mean the dentist is now an MA plan participant (i.e., in network for the MA plan).

A video on CPS continues to be the most accurate information the ADA has on this topic (other than the change in date noted above).

Please direct any questions to dentalbenefits@ada.org or Greg Alterton, CDA’s Dental Benefits Plan Specialist, at (916) 554-5384.

From the June/July 2015 issue of The Nugget.

paid-sick-leaveJuly 1 is just around the corner and so is California’s new Paid Sick Leave Law (AB1522). Beginning on July 1, 2015, all employees who work at least 30 days per year in California are eligible for 24 hours of paid sick leave annually (exceptions include folks in the airline industry and some unions). It is important that you communicate your Paid Sick Leave Plan to your employees prior to July 1, and we are here to help! CEA has created sick leave sample policies for you to include in your employee handbook.

Download the Paid Sick Leave Policy Samples:

Paid Sick Leave – Healthy Workplace Healthy Families Act Fact Sheet
Paid Sick Leave – Accrual Method Sample
Paid Sick Leave – Lump Sum Method Sample

Employers can choose any or all of the following three different options for their employees:

Option 1: Accrual Plan
Employees accrue sick leave from the commencement of employment at a rate of one (1) hour for every 30 hours worked, up to a maximum of 48 hours. Exempt employees’ paid sick leave accrual will be based on a 40- hour workweek.

Option 2: Lump Sum Plan
Employees will be eligible for 24 hours of paid sick leave. Thereafter, you will receive an additional 24 hours of paid leave each year.

Option 3: PTO Plan
You may use your own employer paid time off policy as long as it mirrors or exceeds the accrual, carryover and use requirements in AB 1522, or provides employees with at least 24 hours of paid sick leave each year, regardless of the actual accrual rate. Other Notable Facts:

  • Sick leave is to be paid at the employee’s previous 90 days base rate of pay.
  • Sick leave is not hours worked and is not counted in the calculation of overtime.
  • Employees may use sick leave for the diagnosis, care, treatment of, or preventative care for, the employee’s own health condition or that of a qualifying family member.
  • Qualifying family members include: an employee’s child, parent, spouse, registered domestic partner, grandparent, grandchild, or sibling.
  • Employees may use paid sick leave if they are a victim of domestic abuse, sexual assault, or stalking.
  • Paid sick leave has no cash value upon separation of employment or at any other time.

Thank you to the California Employers Association (an SDDS Vendor Member) for supplying SDDS with information and resources.

By following this link. you will be able to view all of the upcoming California Dental Society Meetings and Events. Thanks to OCDS’ Executive Director, Laura Peterson, for reaching out to the societies and putting this all together!

From the May 2015 issue of The Nugget.

Second Reminder from Dr. Nancy Archibald, SDDS Secretary: By June 1 you must choose to opt in, opt out or become a referring Medicare provider. Doing “nothing” is not an option. If you do “nothing,” your Medicare patients may have to pay out of pocket for a prescription or procedure that would have otherwise been covered by their Medicare benefits. This expense may apply to certain surgical procedures. A sample of the affidavit form is provided on the ADA website. For more information, read the article below:

By Greg Alterton, CDA Dental Benefit Plan Specialist.

Dentists, and other health care providers, have a deadline of June 1 to decide whether they will become part of the Medicare program or not. In considering whether to opt-in or to opt-out of the program, here are some things to consider.

While allowing dentists to opt-into the program, Medicare does not cover routine dental procedures. It will cover certain dental procedures that have a corresponding medical code—mainly oral surgery, perio surgery, and lab work, for example. For specialists, or generalists for that matter, who perform procedures for which there are medical cross-codes, the federal Centers for Medicare and Medicaid Services is allowing an opt-in to Medicare as a provider, which will allow dentists to be reimbursed for those procedures. But again, for basic oral health care—preventive, diagnostic, basic restorative —Medicare doesn’t provide coverage, and most dental care provided to patients who are beneficiaries within Medicare, that care will have to be paid on a cash basis.

Medicare is giving dentists until June 1 to decide if they want to opt-in or opt-out. The opt-out, which most dentists are going for, lets CMS know that you are choosing not to participate in Medicare, and that any services provided to a senior who is in the Medicare program will be provided through private arrangement between the practice and the patient. The provider who opts-out will not be able to submit a claim to Medicare, even if a procedure is a covered benefit in Medicare.

The third option is to enroll with Medicare as an ordering and referring provider. This is a kind of in-between status – neither in nor out. Such a status does not allow the provider to bill Medicare for services, but does put the provider into the Medicare system and eases the care and coverage for a Medicare patient when they are referred to another provider such as an oral surgeon who may be a provider who has opted-in.

What if a dentist chooses to do nothing – neither opt-in, opt-out, nor enroll as a referring provider? A couple of negative things may result. If one does nothing in regard to Medicare, and refers out covered procedures, let’s say a biopsy to a lab, or prescribes medication through a pharmacy, the lab or pharmacy would not be reimbursed by Medicare if the order came from a dentist who wasn’t opted-in, opted-out, or enrolled as a referring provider. So it makes payment for services problematic down the line for the patient if the dentist does nothing. The other negative that could result is that a provider who stays off the grid, so to speak, who treats a Medicare beneficiary, bills that beneficiary for the treatment provided, if then the patient files a claim on their own with Medicare, the provider will likely get a notice from the Medicare administrator (Noridian in California) that they have received a claim from a patient treated by the provider, and that the provider isn’t in the system, so the provider needs to enroll in the system. CDA has received calls from dentists who have received such notices. We have communicated to the administrator that the provider is a dentist, that Medicare will never pay for what the dentist provided the patient, and the administrator has agreed that the dentist doesn’t need to enroll in Medicare. But still, the provider off the books, so to speak, will continue to get these notices when patients submit their own claims to the Medicare administrator. So what CMS has done with the opt-in and opt-out opportunity, and by including dentists in this, is to enable Medicare administrators to either pay dentists for covered medical care, or to recognize that the dentist has opted-out and has the ability to enter into private arrangements with Medicare patients to pay for their own dental care. There is an advantage to a dentist who performs care that is covered under Medicare to opt-in; while there is also an advantage to a dentist who may likely never provide care that is covered under Medicare, to opt-out.

The third alternative—enrolling as a referring provider for Medicare beneficiaries – isn’t an opt-in, and is more like the opt-out. The main benefit of this status is to the patient, and to CMS, which is interested in following a Medicare beneficiary from entry into the healthcare system for their treatment, and follows them to wherever they receive treatment – to a specialist, to use of a lab, to a hospital, a clinic…wherever.

We’re not telling dentists what they should do, but if a dentist wants to occasionally receive some reimbursement for treating a Medicare beneficiary, or if they want nothing to do with Medicare and yet want to make sure they aren’t occasionally badgered by the Medicare administrator about “enrolling,” we hope dentists will consider submitting one of the three options.

The opt-in application, as well as the opt-out affidavit, are to be sent to Noridian Healthcare Solutions, Provider Enrollment, P.O. Box 6770, Fargo, ND 58108-6774 (for northern California, or zip 58108-6775 for southern California). Provider Enrollment at Noridian can be reached at 855-609-9960.

Here are some additional resources:

Opt-in/opt-out resource on cda.org:
cda.org/news-events/deadline-to-opt-in-out-as-medicare-provider

ADA’s opt-out information (requires log-in), which includes a sample affidavit form and private contract for Medicare patients:
success.ada.org/en/practice/medicare/medicare/opting-out-of-medicare

Nordian’s information:
med.noridianmedicare.com/web/jeb/enrollment/opt-out

CMS: Medicare Enrollment Guidelines for Ordering/Referring Providers:
cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedEnroll_OrderReferProv_FactSheet_ICN906223.pdf

A good description of the opt-out process on the website of the Medicare administrator for four Midwest states:
wpsmedicare.com/j5macpartb/departments/enrollment/b_opt_enroll.shtml

From the April 2015 issue of The Nugget.

From Dr. Nancy Archibald, SDDS Secretary: By June 1 you must choose to opt in, opt out or become a referring Medicare provider. Doing “nothing” is not an option. If you do “nothing,” your Medicare patients may have to pay out of pocket for a prescription or procedure that would have otherwise been covered by their Medicare benefits. This expense may apply to certain surgical procedures. A sample of the affidavit form is provided on the ADA website. For more information, read the article below:

By Greg Alterton, CDA Dental Benefit Plan Specialist.
This article was originally published by the CDA in the CDA Update, Vol. 27, Issue 2.A.

A requirement dentists need to keep in mind this year is the designation of their status with the Medicare program. CDA is receiving an increasing number of inquiries about what to consider when choosing your status. Conversations with the ADA and the Medicare administrator for California indicate that additional information, and reminders about the requirement, will be needed as the deadline nears.

Regulations of the Centers for Medicare and Medicaid Services (CMS) require dentists who treat or refer Medicare enrollees or prescribe medication to Medicare patients through the Part D Medicare drug program to either enroll in Medicare as a provider, or opt out of enrollment by June 1.

CDA is aware of services being marketed to dentists by private consultants and businesses to file opt-in or opt-out forms on dentists’ behalf. This service may cost a dentist hundreds, or perhaps thousands, of dollars depending on which option a dentist chooses. While CDA cannot comment on whether the value of these services justifies their cost, it is important for members to know as much as possible about the Medicare requirement prior to committing to an independent consultant service.

There are actually three options for providers: to opt in, opt out or enroll as a Medicare-ordering and -referring provider.

Opt In
The opt-in option allows dentists who perform Medicare-covered services to be reimbursed by Medicare. With some 5 million California beneficiaries in the Medicare program, it’s likely that every dental practice in the state has some patients who are covered under Medicare. Dentists have probably learned that Medicare does not cover routine dental procedures. However, Medicare will cover certain procedures that have a corresponding medical code —mainly oral surgery, periodontal surgery and lab work, for example. If a dentist performs procedures that are benefits in the Medicare program, the opt-in would allow the dentist to be reimbursed for those procedures. Of course, Medicare fees for those procedures would have to be accepted. Medicare.gov provides a search capability to inquire what services are covered by the program.

The point is, there may be little reason for a general dentist to opt in to Medicare as a formal provider of services, unless their practice performs procedures that also are designated as medical.

Opt Out
The opt-out option lets the CMS know that dentists are choosing not to participate in Medicare, and that any services provided to a senior who is in the Medicare program will be provided through a private arrangement between the practice and the patient. The provider who opts out will not be able to submit claims to Medicare, even if a procedure is a covered benefit in Medicare. However, services ordered or referrals made for services that are performed by other providers (physicians, pharmacists) will be reimbursed if those services are prescribed by a dentist who has opted out.

To opt out, a dentist must submit an affidavit to that effect to the Medicare administrator (Noridian, in California), and provide his or her patients who are covered by Medicare with a private contract specifying that payment for dental care will be paid by the patient and that the dentist will not be submitting a claim for the care to Medicare. ADA has provided samples of both the affidavit and the private contract on its website: success.ada.org/en/practice/medicare/medicare/opting-out-of-medicare. Note that a member login to the site is required.

Ordering and Referring Provider
The third option is to enroll with Medicare as an ordering and referring provider. This is a kind of in-between status – neither in nor out. This status does not allow the provider to bill Medicare for services, but does put the provider into the Medicare system and eases the care and coverage for a Medicare patient when they are referred to another provider, such as an oral surgeon, who may be a provider who has opted in. Enrolling as an ordering and referring provider also allows pharmacists and labs to be reimbursed by Medicare for prescriptions and lab services, such as biopsy analyses, when ordered by the dentist. The advantage of this status over the opt-out status is that a provider who opts out will need to renew that opt-out status every two years.

An ordering and referring provider may have up to five years to renew that status. CMS provides additional information about ordering and referring providers here (cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedEnroll_OrderReferProv_FactSheet_ICN906223.pdf).

Doing Nothing
What if a dentist chooses to do nothing – not opting in, opting out or enrolling as a referring provider? If you never expect to treat or write prescriptions for Medicare-covered patients, doing nothing by June 1 is an option. However, a couple of negative things may result. If one does nothing in regard to Medicare, and refers out for covered procedures, let’s say a biopsy to a lab, the lab would not be able to get reimbursed by Medicare if the biopsy came from a dentist who wasn’t opted in, opted out or enrolled as a referring provider. So it makes payment for services problematic down the line for the patient if the dentist does nothing.

Another negative could result if a provider who for Medicare is off the grid and treats a Medicare beneficiary and bills that beneficiary for the treatment provided. If the patient files a claim on their own with Medicare, the provider could get a notice from a Medicare administrator stating the provider needs to enroll in the system.

CDA has received calls from dentists who have been sent such notices. We have communicated to the administrator that the provider is a dentist, that Medicare will never pay for what the dentist provided the patient and the administrator has agreed that the dentist doesn’t need to enroll in Medicare. But still, the provider who is off the books, so to speak, could continue to get these notices when patients submit their own claims to the Medicare administrator. This is one reason for the private agreement between the dentist and the patient, so the patient understands that the services to be provided are not covered by Medicare and that Medicare will not be billed for the services.

What CMS has done with the opt-in or opt-out opportunity, and by including dentists in this, is enabled Medicare administrators to either pay dentists for covered medical care, or to recognize that the dentist has opted out and has the ability to enter into private arrangements with Medicare patients to pay for their own dental care. So, there is an advantage for a dentist who performs care that is covered under Medicare to opt in; while there is also an advantage to a dentist who may likely never provide care that is covered under Medicare to opt out.

Should you choose to opt out, the affidavit is to be sent to Noridian Healthcare Solutions, Provider Enrollment, P.O. Box 6770, Fargo, ND 58108-6774 (for Northern California, or ZIP code 58108-6775 for Southern California). You can also contact Noridian for additional information at 855.609.9960. Noridian maintains an “opt-out” site at med.noridianmedicare.com/web/jeb/enrollment/opt-out.

From the March 2015 issue of The Nugget.
Reprinted with permission from CDA.

The Americans with Disabilities Act (AwDA) became law in July 1990. The AwDA and related state and federal laws prohibit discrimination on the basis of disability in employment, government, public accommodations, education, commercial facilities, telecommunications, and transportation. The law also helps guarantee access to places of public accommodation for persons with disabilities. Dental offices are viewed as places of public accommodation. Therefore, compliance with these laws in dental practices can take several forms, including:

  • Removal of barriers which may impair patient or employee access when it is “readily achievable.”
  • Proper design of office spaces to accommodate the needs of employees and patients in the case of new offices and some remodeling projects.
  • Communication being offered in forms which are readily understood by employees and patients. This may include the obligation to provide sign language interpreters at no cost to the patient.
  • Application of patient management and financial policies that are not discriminatory.
  • Responsible hiring practices which prohibit discrimination against those with physical or mental impairment coupled with reasonable accommodations for employees.

Who is considered disabled under the AwDA?
In general, the group includes those with a physical or mental impairment that substantially limits one or more of life’s major activities, those who have a record of such an impairment, and those who are regarded as being disabled. Some disabilities are obvious, others are not. In the time since the AwDA became law, the courts have deliberated on cases where the questions revolve on whether a particular “disability” is indeed a disability under the law. When dealing with someone who claims a disability, it is best to act in compliance with the law even if you are uncertain about the law’s applicability in the individual case.

Physical Accessibility Standards
California’s disability access guidelines were in place before the AwDA access regulations were adopted. Trying to comply with both sets of detailed standards has been difficult for many businesses. It is not unusual for a building to meet local building code standards while still leaving the building owner or operator vulnerable to disabled access lawsuits. California law allows private enforcement of accessibility regulations, that is, private parties may sue entities to force compliance with regulations, to recover costs of litigation and to have punitive damages assessed.

Detailed information on complying with both state and federal accessibility standards is now available for building and business owners. The Division of the State Architect has on its Web site a reference manual for compliance with physical accessibility standards, www.dgs.ca.gov/dsa/Programs/progAccess/accessmanual.aspx. Local building departments use these standards and have the authority to interpret and enforce state building codes to best fit community needs.

If you are planning construction or a remodel of your facility, take a close look at the most commonly used public areas – the parking lot, walkway, entrance, lobby, and bathrooms. Also consider including appropriate signage. If you have concerns about the accessibility of your office, experts recommend you hire a consultant who specializes in both state and federal disability access laws and regulations to inspect your office. Certified Access Specialists (CASps) are certified by the Division of the State Architect, and a list of them can be found here, www.dgs.ca.gov/dsa/Programs/programCert/casp.aspx. State law provides some protection from lawsuits for businesses that follow through on CASp recommendations to make their businesses accessible.

Also see “Best Defense Against Disability Lawsuits: Compliance,” available on cda.org/compass, www.cda.org/LinkClick.aspx?fileticket=k_rJO7ap3E0%3d&portalid=0.

Communicating with the Hearing-Impaired
You are required to communicate with a deaf or hearing-imparied patient so that the patient is able to understand what you are telling them. The options for communicating to a hearing-impaired patient include using:

  • Printed or written instructions, questions, responses via paper and pen, computer, or other device
  • Lipreading
  • Sign language

It is best to ask the patient what is his or her preferred method of communication. Not all hearing-impaired patients ask a dental practice to provide a sign language interpreter. Be prepared, however, to provide an interpreter if requested.

You may not charge the patient for the cost of providing the interpreter or for any other cost associated with ensuring you and your patient are able to communicate.

A list of organizations that provide sign language interpreters or referrals to interpreters can be found in the Directory section of cdacompass.com.

Employment
Employers are prohibited from discriminating against an employee or potential employee because of the individual’s disability. Decisions to hire, to terminate employment, or to discipline should not be influenced by disability status.

The U.S. Equal Employment Opportunity Commission answers questions about health care workers and the Americans with Disabilities Act on a Web site, www.eeoc.gov/facts/health_care_workers.html. Topics include disability accommodation, “direct threat to safety,” job requirements vs employee essential functions, and more.

Questions & Answers

How can staff determine whether a dog that a patient has brought is a legitimate service animal?
A service dog, or a service dog-in-training, should be on a leash and tagged as a guide dog, signal dog, or service dog by an identification tag issued by the county clerk, animal control department, or other authorized agency. The owner of a service dog is liable for any damage done by the dog to property or injury to individuals. Service animals are addressed in California law under Civil Code Section 54.1 through 54.7.

Is a service dog-in-training allowed the same access to a dental office as a certified service dog?
Yes, according to California Civil Code section 54.2 an individual who is licensed or otherwise authorized to train guide dogs, signal dogs, or service dogs has a right to be accompanied by a dog-in-training in public places without being required to pay an extra charge or security deposit. As with a service dog, a dog-in-training should be on a leash and tagged as a guide dog, signal dog, or service dog by an identification tag issued by the county clerk, animal control department, or other authorized agency. The individual shall be liable for any damage done to the premises or facilities by his or her dog. For more questions and answers on service dogs, see this U.S. Department of Justice Web site, www.ada.gov/qasrvc.htm.

A deaf patient insists I use a specific sign language interpreter. One of my staff knows sign language and I prefer to use my staff to interpret for this patient. Do I have to use the patient’s preferred interpreter?
The U.S Department of Justice address this situation in its Technical Assistance Manual, available here www.ada.gov/taman3.html:

Who decides what type of auxiliary aid should be provided?
Public accommodations (such as dental practices) should consult with individuals with disabilities wherever possible to determine what type of auxiliary aid is needed to ensure effective communication. In many cases, more than one type of auxiliary aid or service may make effective communication possible. While consultation is strongly encouraged, the ultimate decisions as to what measures to take to ensure effective communication rests in the hands of the public accommodation, provided that the method chosen results in effective communication.

Illustration: A patient who is deaf brings his own sign language interpreter for an office visit without prior consultation and bills the physician for the cost of the interpreter. The physician is not obligated to comply with the unilateral determination by the patient that an interpreter is necessary. The physician must be given an opportunity to consult with the patient and make an independent assessment of what type of auxiliary aid, if any, is necessary to ensure effective communication. If the patient believes that the physician’s decision will not lead to effective communication, then the patient may challenge that decision under Title III by initiating litigation or filing a complaint with the Department of Justice (see III-8.0000).

Other Resources
Complying with federal and state disability access laws can be complex. It is important to realize that local agencies also may impose additional requirements. This article and the resources listed below provide you with general information. For assistance in cases related to physical accessibility requirements, you should work with your local building department and your architect or building contractor. An attorney should be consulted in specific cases pertaining to disability discrimination.

On cda.org/compass, see “Best Defense Against Disability Lawsuits: Compliance”

www.cda.org/LinkClick.aspx?fileticket=k_rJO7ap3E0%3d&portalid=0
For full text of referenced laws and additional information, visit:
U.S. Department of Justice ADA Homepage www.usdoj.gov/crt/ada/adahom1.htm
California Disability Access Information www.disabilityaccessinfo.ca.gov
California Department of Rehabilitation www.rehab.ca.gov

From the February 2015 issue of The Nugget.
Reprinted with permission from CDA.

Following the October 2014 reclassification under federal law of hydrocodone combination products (HCPs) such as Vicodin and Norco from federal Schedule III to federal Schedule II, some dentists report pharmacies refusing to fill emergency prescriptions telephoned in for HCPs, under circumstances in which they may traditionally have been accepted. This article is intended to clarify the state of the law with regard to such HCPs and help dentists understand the requirements and limitations on oral prescriptions for a Schedule II drug.

Under both federal* and California law,** the requirements for Schedule II drugs specify that prescribers may only telephone in prescriptions for Schedule II drugs in very limited emergency situations. However, as some differences between federal and California law may be a source of confusion, to ensure a patient’s need for pain medication is met appropriately, dentists should be aware of the following information:

With regard to emergency prescriptions, federal law limits its definition of an “emergency situation” authorizing the issuance of an oral prescription for a Schedule II to those situations in which the prescriber determines:

  • Immediate administration of the controlled substance is necessary for proper treatment of the intended ultimate user.
  • No appropriate alternative treatment is available, including administration of a non-Schedule II drug.
  • It is not reasonably possible for the prescribing practitioner to provide a written prescription to be presented to the dispenser, prior to dispensing.

Further, federal law permits a pharmacist to dispense a Schedule II drug based on an oral authorization from a prescriber only when:

  • The quantity prescribed and dispensed is limited to an amount adequate to treat the patient during the emergency period.
  • The prescription is immediately reduced to writing by the pharmacist and contains all the legally required information.
  • The prescriber is either already known to the pharmacist or the pharmacist makes a reasonable effort to determine that the oral authorization came from an authorized prescriber, which may include calling back the prescriber or other efforts to verify identity.
  • Within seven days after authorizing an emergency oral prescription, the prescriber delivers (or mails) a paper or electronic prescription for the emergency quantity prescribed to the dispensing pharmacist that, in addition to conforming to the other requirements, must have written on its face “Authorization for Emergency Dispensing” and the date of the oral order.

The pharmacist must notify the Drug Enforcement Administration (DEA) if the prescriber fails to deliver the paper or electronic prescription in a timely manner, and failure by the pharmacist to do so renders the prescription invalid.

California law on emergency dispensing for Schedule II drugs is similar to the federal requirements, and dentists should also be aware of the emergency dispensing limits that apply under state law. For instance, California law defines an emergency justifying dispensing pursuant to an emergency oral prescription for a Schedule II drug only “… where failure to issue a prescription may result in loss of life or intense suffering …”

With the increasing scrutiny of opioid abuse, the pharmacy profession, which is regulated by the California Board of Pharmacy, has been charged with enforcing its responsibility to reduce the use of addictive substances, and interprets narrowly the circumstances where “intense suffering” may require a Schedule II prescription; this has historically been primarily limited to patients in hospice care and in skilled nursing and long-term care facilities. This may result in the pharmacist who receives a call from a dentist for an emergency Schedule II prescription counseling the prescriber on other options for pain relief that are not Schedule II.

When an emergency prescription is accepted by the pharmacist, it is similarly subject to several stringent requirements under California law, including that the pharmacy reduces any oral order to hard copy form prior to dispensing the controlled substance and that the prescriber provides a written prescription on a controlled substance prescription form that meets state requirements, by the seventh day following the oral order. California law also requires the pharmacy to notify the Department of Justice in writing within 144 hours of a prescriber’s failure to supply the required follow-up written prescription.

Dentists should anticipate these new barriers to prescribing emergency pain relief to patients using Schedule II drugs and should make every attempt possible to provide the patient with a written prescription. As a last result, if a dentist must telephone in a prescription for a Schedule II drug, the prescriber should provide only the number of pills required to address the emergency, be prepared to explain to the pharmacist how the failure to provide a patient with the drug is medically necessary and/or may result in intense suffering, why a written prescription is not possible, and assure the pharmacist that a written prescription that complies with all requirements will follow within seven days.

A dentist should also consider the effectiveness of prescribing a Schedule III drug instead and is encouraged to talk with pharmacist colleagues about any new contemporary pain relief medications that may fit the patient’s circumstance.

If a pharmacy refuses to fill a prescription for what you believe is an emergency that meets the standards as outlined in state law, please report the incident to CDA Practice Support at 800.232.7645. CDA continues to discuss the situation with the California Board of Pharmacy and California Pharmacists Association.

*21 CFR § 290.10, and 21 CFR § 1306.11(d)
** California Health and Safety Code section 11167

From the December 2014 issue of The NuggetReprinted with permission from the California Employers Association.

California has released a revised Whistle blower Protections Posting. The new required posting, which must be 14 pt font:

  • Expands the rights and responsibilities under the California Whistle blower Laws.
  • Refers to the laws under CA Labor Code 1102.5, and extends protections to employees who report suspected illegal behavior internally to a person with authority to investigate or correct a violation or externally to a public body conducting a hearing or investigation.

More poster changes will take place between now and the end of 2014, so instead of buying a new poster today, we suggest you download the free posting at www.dir.ca.gov/dlse/WhistleblowersNotice.pdf. Downloaded postings meet an employer’s legal obligation and will hold you over until the 2015 California/Federal All In One posters are ready.

Look for the poster in your January 2015 Nugget!

January 2015 Nugget

By Ann Milar, CDA Dental Benefits Analyst (2015 MidWinter Speaker)

Dentists need to ensure that their practices are prepared for dental procedure code changes that go into effect Jan. 1. There are 73 code changes, including 16 new procedure codes.
The ADA released the latest version of the Current Dental Terminology (CDT) Codes earlier this year.

The 16 new procedure codes include the following:

  • Re-evaluation at a postoperative office visit;
  • 3-D photographic image;
  • 3-D photographic image;
  • Sealant repair, per tooth;
  • Cleaning and inspection of removable appliances;
  • Retainers for resin bonded fixed prosthesis;
  • Missed and cancelled appointments;
  • Administrative issues; and
  • Evaluation for deep sedation or general anesthesia.

There are 52 code revisions, including these revised procedure codes:

  • Topical application of fluoride;
  • Coping;
  • Inlay/onlay restorations;
  • Clinical crown lengthening,
  • Hard tissue;
  • Osseous surgery;
  • Implant/abutment supported removable dentures;
  • Peri-implant defects;
  • Placement of temporary anchorage devices;
  • Incisional biopsies; and
  • Sedation.

Five codes have been deleted from CDT:

  • D6053 Implant-/abutment-supported removable denture for completely edentulous arch;
  • D6054 Implant-/abutment-supported removable denture for partially edentulous arch;
  • D6078 Implant-/abutment-supported fixed denture for completely edentulous arch;
  • D6079 Implant-/abutment-supported fixed denture for partially edentulous arch; and
  • D6975 Coping.

Please remember that while dental plans are required to recognize current CDT codes, they are not required to pay or provide benefits for new codes as they become effective. Dental offices are encouraged to review dental plans’ payment and processing guidelines to determine whether benefits are payable and any documentation requirements.

Copies of the CDT 2015 (both hard copy and e-book) are available for purchase through the American Dental Association’s website, ADAcatalog.org.

In 2015, CDA will offer members many dental benefit educational opportunities. Below is a chronological listing of deadlines and dates.

Dental Benefits Workshop – Sacramento (April 16-17, 2015)
This two-day CDA Dental Benefits Workshop in Sacramento will provide dentists with the skills to improve practice profitability and the confidence to work with dental plans on their terms. Registration and workshop details can be found at cda.org/dbw.

Medicare Enroll/Opt-Out Deadline (June 1, 2015)
June 1 is the deadline for dentists to enroll or opt out as Medicare providers. Regardless of which direction a dentist elects to go, this process can take several months, so dentists are encouraged to evaluate practice operations and determine which option is best for their patients and their practice well in advance of the June 1 deadline. More information regarding Medicare enrollment/opt-out can be found via the following websites: cda.org, ada.org and cms.gov.

ICD-10 Code Implementation (Oct. 1, 2015)
Effective Oct. 1, the ninth edition of the International Classification of Diseases (ICD) code sets will be replaced by ICD-10. The ICD-10 includes greater specificity than ICD-9 and more than 70,000 detailed diagnostic codes.

While dentists are not required to submit diagnostic coding for dental claims, dentists who perform oral surgery, treat temporomandibular disorders, facial pain and sleep apnea, treat patients in a hospital or outpatient surgery center and submit claims to medical plans may need to utilize the new ICD-10 diagnostic codes to ensure timely payment for treatment.

More information regarding ICD-10 can be found at cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10.

December 2014 Nugget

Reprinted with permission from the California Employers Association.

California has released a revised Whistle blower Protections Posting. The new required posting, which must be 14 pt font:

  • Expands the rights and responsibilities under the California Whistle blower Laws.
  • Refers to the laws under CA Labor Code 1102.5, and extends protections to employees who report suspected illegal behavior internally to a person with authority to investigate or correct a violation or externally to a public body conducting a hearing or investigation.

More poster changes will take place between now and the end of 2014, so instead of buying a new poster today, we suggest you download the free posting at www.dir.ca.gov/dlse/WhistleblowersNotice.pdf. Downloaded postings meet an employer’s legal obligation and will hold you over until the 2015 California/Federal All In One posters are ready.

Look for the poster in your January 2015 Nugget!

December 2014 Nugget

Reprinted with permission from CDA.

California’s data breach notification law will undergo amendments effective Jan. 1, 2015. Some reports have indicated that AB 1710 will require companies to provide credit monitoring in the event of a data breach, which is not true.

It does state, however, that when companies experience a data breach and decide to offer credit monitoring to affected individuals, they must offer the services at their own expense and for no less than one year. The breach notification must also contain all material information individuals need to take advantage of the offer.

California’s data breach notification law requires any person or business in California that owns or licenses individuals’ computerized personal information to notify any resident of California following the discovery of a breach of their unencrypted personal information.

“Personal information” is defined as a person’s first name or first initial and last name in combination with any of the following:

  • Social security number.
  • Driver’s license number or California identification card number.
  • Account number, credit/debit card number, in combination with any required security code, access code or password that would allow access to the person’s financial account.
  • Medical information, defined as “any information regarding an individual’s medical history, mental or physical condition, or medical treatment or diagnosis by a health care professional.”
  • Health insurance information, defined as “an individual’s health insurance policy number or subscriber identification number, any unique identifier used by a health insurer to identify the individual, or any information in an individual’s application and claims history, including any appeals records.”
  • A username or email address, in combination with a password or security question and answer that would permit access to an online account.

As stated above, the amendment does not require offering affected individuals credit monitoring. Companies often offer credit-monitoring services after a data breach, particularly when the breach involves an individual’s social security number. If the decision to offer credit monitoring is made, the offer must be in compliance with the amended law starting Jan. 1, 2015.

Encrypting data provides a safe harbor from breach notification. The recently released 2014 California Data Breach Report, published by the office of the California attorney general, reports that 70 percent of health care sector data breaches in 2012 and 2013 were the result of lost or stolen hardware or portable media containing unencrypted data.

The Executive Summary of the attorney general’s report states, “A recent study by the Ponemon Institute reports that criminal attacks targeting the health care system are growing and that employees’ use of unsecured portable devices is also increasing the risk of breach. The need to use encryption is a lesson that must be learned by the health care industry and we recommend that it be applied not only to laptops and portable media, but also to many computers in offices.”

Encrypting data on office computers and any removable media (such as USB sticks, tablets, smartphones, backup tapes) that contain personal information is highly recommended. In addition to providing safe harbor under California’s data breach notification law, encrypting electronic health information also provides a safe harbor under HIPAA’s data breach notification rule.

The full 2014 California Data Breach Report can be found here. It provides information on data breaches in California broken down by sector and type of breach. It also provides recommendations as to how businesses can protect their customers.

CDA Practice Support has several resources on preventing and responding to data breach incidents, including information on encryption and a sample data breach notification letter. They can be found at cda.org/practicesupport.

November 2014 Nugget

By Ben Cope, DDS 

The issue: On Aug. 22, 2014, the DEA declared that any hydrocodone containing medication is now regulated as a schedule II drug. The practical implications for a dentist are that we now have to hand write prescriptions for common narcotic pain relievers such as Norco. If a patient calls in with pain after hours or over the weekend, we would have to see them in person every time to hand write the prescription; no more calling it in to the pharmacy. This could become a huge inconvenience, and may result in more and more patients seeking emergency room treatment if their dentist is unavailable to meet them in person.

The solution: According to pharmacists, a dentist can still call in drugs like Norco (or any schedule II drug for that matter) as long as a few criteria are met:

  1. It must be an emergency situation (as defined by the dentist).
  2. It must be after-hours.
  3. The dentist can only prescribe enough to get the patient through the emergency situation (usually limited to 72 hours)
  4. The pharmacy must receive a hard copy of what the dentist phoned in. The next time the dentist is in office, he/she must physically write out the prescription
  5. This hard copy must be mailed to and received by the pharmacist within 7 days
  6. This hard copy must have the phrase “Authorization for Emergency Dispensing”, along with the date you called it in.

This information has been verified verbally with the Sacramento branch of the DEA, as well as the source information in the Code of Federal Regulation, title 21, sections 1306.11 and 290.10.

November 2014 Nugget

Reprinted with permission from CDA. 

Dentists are reminded that starting Oct. 6, hydrocodone combination products such as Vicodin and Norco are classified as Schedule II drugs and require Schedule II authority to prescribe. CDA reminds dentists to visit the DEA’s website to ensure their registration is up-to-date. Pharmacists will be checking the website for proper authority before filling Schedule II prescriptions. Dentists whose registration status is not updated should anticipate receiving pharmacists’ phone calls prior to filling prescriptions for Vicodin, Norco or similar products.

For more information, read the Sept. 23 CDA article titled “Hydrocodone reclassification set for Oct. 6.”

October 2014 Nugget

By Leslie Canham, CDA, RDA 

Regulations pertaining to healthcare and dentistry are constantly changing. There are new OSHA, HIPAA, and Dental Practice Act regulations that require dentists to take action.  Here are a few of the tasks you need to complete to be IN COMPLIANCE.

OSHA

The New Hazard Communication Standard

The OSHA Hazard Communication Standard became effective in 2013. Dentists  must train their workers in the new label and safety data sheet (formerly called MSDS) requirements by December 1, 2013.

Aerosol Transmissible Diseases
In 2009, OSHA issued a requirement for dental practices to train employees in Aerosol Transmissible Diseases (ATDs). The dental practice must have written injury and illness preventions plans addressing ATDs and adhere to the CDC Guidelines for screening patients who may be infected with an ATD.   ATDs include all types of influenza, varicella diseases, measles, smallpox, SARS, TB and other diseases and pathogens.

Bloodborne Pathogen Training
OSHA requires that employers ensure that all clinical employees participate in a training program. Training shall be provided at the time of initial assignment and at least annually thereafter. Documentation of the training must be maintained by the employer for at least 3 years.

New HIPAA Regulations require covered entities to complete required tasks

In January 2013, the new HIPAA Omnibus Final Rules were published implementing changes to HIPAA Privacy, Security, Breach Notification and Enforcement Rules.  All covered entities must revise their written policies and procedures to comply with the new rules. Training must be provided to workforce, both clinical and administrative.

Here are some of the things you need to do:

  1. Conduct and document a “Risk Assessment”
  2. Re-write and post your HIPAA Notice of Privacy Practices.
  3. Update your Business Associates Agreements and have each business associate sign the new agreement.
  4. Create new written plans to demonstrate how the dental practice will adhere to HIPAA regulations.
  5. Train your workforce on the new regulations.
  6. Understand how to prevent breaches and know when you must provide breach notification to patients.
  7. Create various Logs:

Amendment Request Log
Disclosures of Patient Information Log
Complaint Log
Breach Log
Security Incident Log
Emergency Access Log
Maintenance Repair Log
Electronic Media and Hardware Movement Log

I highly recommend that your practice purchase the American Dental Association (ADA)  “Complete HIPAA Compliance Kit ” where you can find the written forms and logs.

Dentists and Hygiensists to provide “Notices To Consumers”

Two separate “Notice to Consumers” posters are required for both dentists and dental hygienists informing patients that Dentists/Dental Hygienists are licensed and regulated by the Dental Board of California/Dental Hygiene Committee of California.  The phone number and website of  the Dental Board of California/Dental Hygiene Committee of California must also be on the poster.  All letters must be in 48 point font.

Unlicensed Dental Assistants

If hired after 1-1-2010, unlicensed dental assistants must possess the 8 Hour Infection Control certificate, take a Dental Practice Act course and hold a current CPR certificate. The supervising
is responsible for assuring dental assistants obtain these certificates within 1 year of employment.

If you would like a complimentary copy of a HIPAA Compliance Checklist, send an email to Leslie@LeslieCanham.com

In the dental fielded since 1972, Leslie helps dental teams simplify complex regulations. She provides in-office training, mock-inspections, consulting, and hands on implementation of HIPAA. Contact Leslie at 209.785.3903 or www.LeslieCanham.com.

(as of August 2014)

The X-ray machine owner is responsible for reporting the purchase, transfer, sale, or disposal of radiographic equipment to the state Department of Public Health. A form plus evidence of the purchase, transfer, sale, or disposal must be provided to the department.

(as of August 2014)

By Hilary Johnson, SDDS Member Liaison

The CDC has declared that prescription drug abuse is an epidemic in the Unites States. As a prescriber, what can one doctor do to prevent the further spread of prescription drug abuse? The California Department of Justice has an answer! The Controlled Substance Utilization Review and Evaluation System (CURES)/ Prescription Drug Monitoring Program (PDMP) system allows prescribers, pharmacists, law enforcement, and regulatory boards to access timely patient controlled substance history information.  If you think your patient may be a drug seeker, you can look him up in the CURES/PDMP database and the data may help you determine whether or not you want to prescribe to that patient.

SDDS has been getting an influx of calls wondering how to identify drug seekers and disseminate that information. Due to HIPAA regulations, neither doctors nor SDDS can release any patient information without the patient’s consent, unless the organization is working under the direction of law enforcement. Thankfully, the CURES/PDMP system allows prescribers to make informed decisions regarding their patients’ needs and avoid prescribing unnecessary medicines.  We would like to encourage all of our members to register for access to the system.

In order to access the CURES/PDMP database, you must register. There is no charge. Visit aaicures.com/register.for.access.php and follow the instructions to register! You must mail a notarized copy of your DEA Registration, CA License and state-issued ID after you complete the electronic registration. We believe our members are the best dentists in the region, and we want to provide you with the best tools for your arsenal. CURES registration will be mandatory by January 1, 2016 for all prescribers registered with the DEA.

If you discover a drug seeker, you can report it online at www.deadiversion.usdoj.gov/rxaor/ or you can call 1-877-RX-Abuse (1.877.792.2873). Identifying and denying just one drug seeker may be preventing a death!

(as of August 2014)

CDA Practice Support has received an increase in calls regarding the so-called “paperless mandate.” The calls are coming from dentists who were told by other dentists that the deadline to switch to dental electronic health records (EHR) is coming in 2015.

CDA reminds dentists that there is no requirement for dental practices to go paperless. There is an incentive program for Medicaid/Medicare providers to convert to electronic health records, however. Dentists who bill Medicare and who do not convert to EHRs will eventually see reduced payments for services.

Those Medicare payment reductions will begin in 2015. This will happen for most providers who are eligible but choose not to participate, according to the ADA. The ADA says, “The reductions will be enforced at the rate of 1 percent beginning in 2015 and will increase by 1 percent per year to a maximum of 5 percent.”

Dentists who do not participate in Medicare and are not eligible to participate in the incentive program.

EHRs are changing practices rapidly as related to benefits and clinical operations. There are many options in terms of vendors and software offerings in addition to the federal EHR incentives, new Health Insurance Portability and Accountability Act (HIPAA) rules and the push to move everything to the cloud.

For dentists who are making the transition to EHRs, CDA has the following resources available: The Dental Software Evaluation and Selection Checklist, Dental Software Contracts Checklist and Dental Software Implementation and Training Checklist. These resources prompt dentists to consider how they may address issues that arise during the software implementation phase. A veteran in the information technology profession and several electronic health experts developed the checklists.
Member dentists can find these resources by typing in the names of each resource in the Search Resources box on cda.orgpracticesupport.

(as of June 2014)

Secure electronic transmission of protected health information is one of the many requirements of the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. Dental practices should review the rule requirements to ensure compliance. More and more resources are becoming available for dentists to use to stay compliant.

The ADA has launched a new kit, for example, that helps dental practices comply with HIPAA. The ADA Complete HIPAA Compliance Kit includes a Privacy and Security Manual that outlines privacy, breach notification and security compliance in a step-by-step format. It also includes a Practical Guide to HIPAA Training that has two levels of training. Level 1 targets dental office personnel with the basics of HIPAA compliance. Level 2 targets managers to help them develop and implement a HIPAA compliance program for their offices.

ADA also is offering a three-year subscription to the HIPAA Compliance Update Service that advises subscribers whenever federal HIPAA laws change.

CDA’s HIPAA Security Rule: A summary resource can be found on cda.org/Privacy-HIPAA. Also, the Department of Health and Human Services has a Guidance on Risk Analysis resource on its website hhs.gov.

Congress passed HIPAA in 1996 to simplify, and thereby reduce the cost of, the administration of health care. HIPAA does this by, among other things, establishing standard codes and identifiers and encouraging the use of electronic transactions between health care providers and payers. Congress deemed that if the electronic transmission of patient health information was to be encouraged by the legislation, there needed to be means to protect the confidentiality of that information, and thus, the HIPAA Security Rule was created. With the exception of small health plans, which had a later compliance date, covered entities had to be compliant with the rule by April 20, 2005.

After establishing a “security officer” in the practice (similar to the designation of a privacy officer as required by the HIPAA Privacy Rule), conducting a documented risk analysis on their practices’ information systems is the first step dentists can take to be in compliance with the HIPAA Security Rule. Other things dentists can do to protect themselves include, among other things, instituting a system to regularly review records of information system activity, such as audit logs, access reports and security incident tracking reports, and having business associate agreements that require compliance with the Security Rule and notification of data breaches that occur with the respective business associate.

For pricing and to purchase the ADA Complete HIPAA Compliance Kit, visit ebusiness.ada.org

(as of May 2014)

On Monday, March 24th, trial lawyers and their allies filed signatures with county elections officials to begin the process of qualifying their anti-MICRA ballot initiative for November 2014. Californians Allied for Patient Protection (CAPP) has been preparing for this battle since the coalition was formed in 1991. The coalition of nearly 1,000 members, including SDDS, CDA, TDIC, and every dental society in California, is well positioned to make sure MICRA is protected. The committee Patients and Providers to Protect Access and Contain Health Costs has been formed to defeat this ballot measure.

For more information or to get involved visit noon46.com or contact CAPP Executive Director Lisa Maas at LMaas@micra.org.

(as of May 2014)

Inquiries have increased to CDA Practice Support recently on the subject of movie licensing. Dental practices are being contacted by mail or in person by individuals seeking to collect licensing fees. Many dentists assume it is OK to play movies they have purchased in their waiting rooms, but that is not always the case.

For more information, review the Legal Reference Guide for California Dentists HERE.

(as of May 2014)

CDA’s arbitration with Delta took a step forward on Feb. 25 with a “preliminary hearing” conference call with the panel of arbitrators assigned to the case. The purpose of the call was to schedule dates for different stages of the arbitration.

In light of the extensive briefing that has already been submitted by both parties, the panel of three arbitrators has indicated it will likely decide two significant issues by early April. The first is CDA’s “Application to Preserve the Status Quo,” which would prevent Delta’s amendments to provider contracts from being deemed effective as of Oct. 4, 2013. CDA is challenging the legality of Delta’s proposed changes to provider agreements which would eliminate a current requirement that Delta provide justification for changing its reimbursement rates and restrict dentists’ ability to use arbitration to challenge Delta’s actions. The second issue is Delta’s argument that CDA itself should not be permitted to appear in the arbitration on behalf of its members. The arbitrators concluded that these important initial issues should be decided before proceedings continue.

Delta also announced that it intends to file a “dispositive motion,” which it described only vaguely. CDA believes Delta plans to urge the arbitration panel to dismiss CDA’s claims because the Department of Managed Health Care has already approved the two amendments that are challenged in the litigation. CDA questions the strength of this motion, in light of the fact that Delta filed its application with the DMHC as a confidential filing, allowing no comment by anyone affected by it. CDA does not believe the DMHC intended its approval of Delta’s filing to have any preclusive effect on the rights of dentists. The parties have agreed to a briefing schedule so that this motion will be heard by the arbitrators on May 5.

At that same hearing, arbitrators will consider the issues of discovery, exchange of exhibits, depositions and any similar issues. We expect that the arbitrators will also set a date for the arbitration hearing itself, either at the May 5 hearing or before. We anticipate that the arbitration will be scheduled sometime in August or September.

CDA will continue to keep you informed on the progress of the arbitration in the Update, newsletter and on cda.org

(as of 4-1-14)

Now accepting applications for both the northern and southern committees. More specifically, one (1) Dental Auxiliary (Dental Assistant or Dental Hygienist) and one (1) licensed physician or psychologist are needed for Southern California and one (1) Dentist and one (1) licensed physician or psychologist are needed for Northern California. These committees assist the Board in evaluating licensees who may be impaired due to the abuse of alcohol or drugs. Each committee is composed of three dentists, one dental auxiliary, one physician or psychologist, and one public member who all have experience or knowledge in the field of chemical dependency. Diversion Committee members are appointed by the Board and serve at the Board’s pleasure.

You may find the application HERE.

(as of 3-2-14)

ADA has two new resources to assist dentists with some of the toughest transitions of their careers. The ADA Practical Guides to Valuing a Practice helps dentists understand a practice’s true value, not just its monetary worth. Both buyers and sellers get a balanced view of practice valuation. Refuting many common valuation myths, the book raises awareness of possible legal and tax issues that may arise during the process. It also provides guidance on selling or buying an entire practice, a portion of a practice, and planning a future buy-in or buy-out.

ADA’s other resource, The ADA Practical Guide to Associateships, demonstrates the risks and rewards of adding or becoming an associate – from both points of view. The book provides dentists with information to help them build a successful partnership. Strategies are offered for tackling both logistical issues (such as type of associate arrangement, compensation, contract terms, and buy-ins) and intangible issues (interpersonal considerations and compatibility, developing a practice philosophy, and conducting a goals assessment, for example).

Both books can be ordered on the ADA website: ebusiness.ada.org

(as of 3-1-14)

As questions increase about the use of Botox in dentistry, The Dentists Insurance Company advises California dentists that the use of preparations such as Botox and Dysport must be within the scope of dental practice.

“If doctors are practicing legally within the scope of their dental license, there is coverage under TDIC’s professional liability policy,” said TDIC Underwriting Director Dora Earls. However, Earls noted that if the Dental Board of California determines that use of Botox or similar drugs is not within the scope of dental practice, there is no TDIC coverage.

In California, dentistry is defined by the California Business and Professions Code section1625. The dental board lists the pertinent language of the code as, “diagnosis or treatment, by surgery or other method, of diseases and lesions and the correction of malpositions of the human teeth, alveolar process, gums, jaws or associated structures; and such diagnosis or treatment may include all necessary related procedures as well as the use of drugs, anesthetic agents and physical evaluation …” The board states that a dentist may use any legally prescribed drugs to treat patients as long as the treatment is within this specified scope of practice.

Additionally, in California dentists may not use Botox cosmetically without an Elective Facial Cosmetic Surgery permit issued by the dental board. Licensed dentists who have completed residencies in oral and maxillofacial surgery and additional criteria outlined by the dental board can apply for an Elective Facial Cosmetic Surgery permit. There are two categories for these permits. Category I relates to cosmetic facial surgery, such as contouring of the osteocartilaginous facial structure, and Category II relates to cosmetic soft tissue contouring or rejuvenation. The details of this system can be found in the California Business and Professions Code section 1638.1.

Currently, there are 26 dentists in California with these permits, according to the dental board. The dental board also states, “Some permit holders may not be authorized to perform all cosmetic surgery procedures within the scope of the Elective Facial Cosmetic Surgery permit.” Additionally, the dental board notes that all procedures authorized under the Elective Facial Cosmetic Surgery permit must be performed in an acute care hospital or a certified surgical center as defined in California Business and Professions Code section 1638.1(f).

Botox and Dysport are commercial preparations of botulinum toxin derived from the bacterium Clostridium botulinum, a nerve “blocker” that binds to the nerves and prevents the release of acetylcholine, a neurotransmitter. The result is muscle paralysis, according to the National Center for Biotechnology Information. Botulinum toxin is approved by the FDA, and its most common use is in applications to minimize fine facial wrinkles.

Concerning professional liability coverage and training or certification for dentists to use Botox or similar drugs, TDIC’s endorsement states: “Before performing the alleged injection(s), you must have obtained any license, permit, certification or training required by the state dental licensing authority where you practice.”

For more information or if you have questions regarding this topic, contact the TDIC Risk Management Advice Line at 800.733.0634. The Dentists Insurance Company offers policyholders a free advice line at 800.733.0634 for assistance with questions or concerns about potential liability. TDIC risk management analysts will work with policyholders to develop a solution.

(as of 2-2-14)

In January, dentists receiving their biennial renewal statements from the Dental Board of California (DBC) will see an increase in the total fee from $365 to $377, along with the following information:

“Pursuant to Business and Professions Code Section 208 (SB 809 – DeSaulnier, Chapter 400, Statutes of 2013), you are assessed $6 ANNUALLY which is collected at the time of renewal to cover the operation and maintenance of the Controlled Substance Utilization Review and Evaluation System (CURES). The amount of $12 per renewal cycle is hereby added to the renewal fee.”

CURES is the statewide database, administered by the Department of Justice, that collects information from dispensers of controlled substances for use in carrying out the state’s Prescription Drug Monitoring Program. It is intended to be used by law enforcement and by providers to identify fraudulent “doctor-shopping” for prescription drugs, as well as for law enforcement to identify providers who themselves are overprescribing.

The state’s deficit condition in recent years led to a crippling funding cutback for the CURES program, rendering it all but inoperable except for basic administrative tasks. SB 809 was the culmination of a several-year effort by Sen. Mark DeSaulnier (D-Concord) and Attorney General Kamala Harris to identify a dedicated funding source for maintaining and operating CURES.

The new law calls for the $6 annual licensure fee surcharge to be applied to all licensed professionals who can prescribe drugs, which include physicians, dentists, podiatrists, veterinarians, naturopathic doctors, pharmacists, registered nurses, nurse-midwives, nurse practitioners, physician assistants and optometrists. The fee will also be applied to certain drug wholesalers and clinics.

In addition, the law allows, but does not require, insurers, health care service plans and drug manufacturers to make tax-deductible contributions to the CURES fund. Finally, the new law will, by Jan. 1, 2016, require all prescribing providers to apply to the Department of Justice for access to the CURES database.

“CDA was part of a broad stakeholder group that worked with Senator DeSaulnier and the attorney general’s office as SB 809 moved through the process,” said William L. Marble, DDS, chair of CDA’s Government Affairs Council. “The CURES database is an important part of the state’s efforts to combat prescription drug abuse. Although we advocated for more broad-based funding than what ultimately ended up in the bill, we recognized that it was appropriate for prescribing providers to play a role in making the CURES program effective and sustainable.”

Has Been Amended
(as of 1-1-14)

New CA legislation (SB292) amends the definition of sexual harassment. The bill clarifies the definition of harassment in the Fair Employment and Housing Act to specify that sexually harassing conduct need not be motivated by sexual desire. Every California company with 50 or more employees must provide sexual harassment training to all supervisors and managers every two years and to each new supervisor and manager within 6 months of the assumption of their position. Additionally, employers with less than 50 employees must take all reasonable measures to promote a sexual harassment-free work environment.

(as of 12-2-13)

New changes to the Occupational Safety and Health Administration’s (OSHA) Hazard Communication Standard are bringing the United States into alignment with the Globally Harmonized System of Classification and Labeling of Chemicals (GHS). The new OSHA Standard requires employers to train all employees on the new label elements and Safety Data Sheet (SDS) format by Dec. 1, 2013.

OSHA has updated requirements for labeling of hazardous chemicals under its Hazard Communication Standard (HCS). Manufacturer labels will be required to have picto-grams, a signal word, hazard and precautionary statements, the product identifier, and supplier identification.

Click here for more information.

(as of 12-1-13)

When opening or purchasing a practice, you must register the X-ray equipment. For more information or to register your equipment, please contact:

Radiologic Health Branch
Department of Health Services
P.O. Box 997414
Sacramento, CA. 95899-7414
www.dhs.ca.gov/rhb

(as of 11-1-13)

The Health Officer of Sacramento County is requiring that each health care facility in Sacramento County implement a program requiring its health care workers to receive an annual influenza vaccination or, if they decline, to wear a mask for the duration of the influenza season while working in patient care areas.

The order also applies to dental practices in Santa Clara, Sacramento and Contra Costa Counties. The order, which resumed on Nov. 1 after it was established last year as an official memorandum by the counties, is ongoing and applies to each influenza season unless the order is rescinded. The influenza season is defined as Nov. 1 to March 31 of the following year.

The county of Sacramento is recommending it for dental practices, Members should regularly check the websites of their respective county public health departments for public health orders, information on flu outbreaks, an other information for healthcare providers.

Click here for more information.

(as of 9-10-13)

The Affordable Care Act (ACA) amended the federal Fair Labor Standards Act, indicating that employers should provide a notice to all employees of the existence of the newly formed insurance marketplace available to them along with information on how to contact the insurance marketplace to request assistance in purchasing coverage if the employee chooses to do so.

Specifically, by Oct. 1, all employers covered by the Fair Labor Standards Act, which includes all dental offices, should provide each of their employees a notice that informs the employees that there are new health insurance coverage options for purchase through Covered California. The form is designed to provide information intended to assist employees in evaluating their health and pediatric dental benefit options for 2014. Employees can access information about the options available to them through Covered California at www.coveredca.com or by calling toll-free 888.975.1142.

Click here for more information.

(as of 4-1-11)

Cal/OSHA and the Dental Board do not specifically prohibit staff from keeping long fingernails of using artificial nails. However, if a dental office is concerned that the practice may interfere with maintaining employee and patient safety procedures, the office may adopt a policy limiting fingernail length and prohibiting artificial nails. The CDC recommends this policy.

More Infection Control & CAL/OSHA FAQs can be found here.

Notice of Privacy Practices A HIPAA covered entity is required to provide patients with its notice of privacy practices. The notice must include descriptions of the types of uses and disclosures of protected health information (PHI) that the covered entity is permitted to make without the individual’s written authorization, including for each of the following purposes: treatment, payment, and health care operations. The notice also must include a statement about the other uses and disclosures the practice may use PHI; a statement on the individual’s rights with respect to the information; and description of procedures followed when a patient chooses to exercise those rights.

Click here for a Sample Notice of the HIPAA Privacy Practices.

The U.S. Census Bureau encourages dentists to inform the 2012 economic census by completing survey forms mailed to many private practice dental offices. Not all practices will receive the forms. The economic census is the government’s official five-year measure of American business and the economy.

More information regarding this matter can be found here.

For help with your form and other economic census information click here.

(as of 2-12-13)

The US Department of Labor (DOL) recently issued a final rule implementing two important expansions of the Family and Medical Leave Act (FMLA).

THE UPDATES:

  • Provide service members’ families with FMLA leave for events related to service members’ deployments.
  • Expand coverage given to current military family members to eligible families of veterans.
  • A new provision makes it easier for flight crew employees to be eligible for FMLA and use FMLA benefits.

SPECIFICS: The new FMLA rule implemented Congressional amendments to the FMLA, permitting eligible workers to take up to 26 workweeks of leave to care for a current service member with a serious injury or illness. Congress also created qualifying exigency leave, which permits eligible employees to take up to 12 workweeks of leave for qualifying exigencies arising out of active duty or call to active duty in support of a contingency operation of a family member serving in the National Guard or Reserve. The final rule also implements amendments clarifying the application of the FMLA to airline personnel and flight crews. Until the amendments, many flight crews did not meet FMLA eligibility criteria due to the unique way in which their hours are counted.

The DOL also released a new FMLA poster. The new FMLA poster must be posted by employers covered by the FMLA no later than March 8, 2013. Download the free poster here.

For more information, including the new rule, a military leave guide, fact sheets and other materials, visit the DOL website.

(effective 11-28-12)

As of November 28, 2012, dental practices are required to post a new notice to
consumers. The notice must be accessible to public view on the premises where dental services are provided. The notice must be in at least 48-point type font and include
the following statement and information:

NOTICE TO CONSUMERS
Dentists are licensed and regulated
by the Dental Board of California
(877) 729-7789
www.dbc.ca.gov

Click here to download a copy of the Notice to Consumers.

You can also find the sample notice available for download on cdacompass.com.
Pharmacists and physicians also are required to comply with a similar requirement.

(as of 12-20-12)

Find out, using this checklist!
(Created by CDA Practice Support Center. Registration and login may be required to access material)

HIPAA Training PowerPoint presentation (for staff training) can be downloaded here
(Created by CDA Practice Support Center. Registration and login may be required to access material)

ADA Practical Guide to HIPAA Compliance: Privacy and Security is available for purchase here

HIPAA FAQ’s and articles available here
(Created by CDA Practice Support Center. Registration and login may be required to access material)

(effective 7-1-12)

A new law took effect on July 1, 2012 regarding the required elements for security forms for controlled substances. Security prescription forms for controlled substances must include the preprinted address of the prescriber (Health and Safety Code section 11162.1). Prescription forms not in compliance are invalid and will no longer be accepted. Additionally, licensed health care facilities or clinics exempt under Section 1206 (those having 25 or more licensed physicians or surgeons preprinted on the form) are not required to preprint the category of licensure and license number of their facility or clinic.

View all changes in Pharmacy Law that took effect via this link: http://www.pharmacy.ca.gov/laws_regs/new_laws.pdf.

We know that mercury-containing wastes can threaten our environment. Washed down the drain, or otherwise improperly disposed of, mercury can find its way into Sacramento waterways and the environment. As health care professionals, we play a part in keeping our patients healthy. We also need to show the public that we are good environmental stewards. SDDS is working closely with the Sacramento Regional County Sanitation District to help ensure the dental community knows how they can help.

Please post this poster in your office to remind you of these best practices!

ALSO…

Sacramento Regional County Sanitation District (SRCSD) has partnered with the
Sacramento Area Sustainable Business program to develop a certification for qualified dentists that
voluntarily take actions to prevent pollution by properly disposing of mercury.

(effective 8-20-12)

The Dental Board has amended its infection control regulations, and the amendments went into effect on August 20. A copy of the amended regulations is available on cdacompass.com

The regulations require a written protocol be developed, maintained, and periodically updated for proper instrument processing, operatory cleanliness, and management of injuries. Sample written protocols can be found on cdacompass.com. A future Update article will review the changes in the regulations.