Reprinted with permission from the CDA.

The California Supreme Court on Dec. 22 issued an important decision in a case (Augustus v. ABM) involving the security guard industry. Two issues were in question: Must an employee be relieved of all duty for a paid 10-minute rest period and, if an employee is “on call” during a rest period, does it count as a lawful break?

The answer is yes and no. In its simplest form, the ruling stated that “… state law prohibits on-duty and on-call rest periods. During required rest periods, employers must relieve their employees of all duties and relinquish any control over how employees spend their break time.” What this means for employers of dental practices is that meal and rest break policies must be reviewed and updated to be in compliance with this decision.

Similar to meal periods, employees must now be relieved of all duties for the two 10-minute paid breaks to be lawful. Employees should not be allowed to take rest breaks at their desks or in work areas where the employee could potentially be interrupted and employers are no longer able to have policies that restrict employees from leaving the premises during rest periods.

Employees are entitled to one rest break for workdays 3.5 – 6 hours in length and two rest breaks for workdays that are 6 – 8 hours in length. No rest breaks are required for a workday that ends prior to 3.5 hours. Current meal and rest break penalties still apply. Employees who are not provided an uninterrupted rest break or are not able to take meal breaks are entitled to an additional one hour of pay for each incident (up to two in a single day). The additional time should be provided to the employee on the next regularly scheduled payroll date.

Five things to consider when reviewing employee rest break policies

Employers should ensure the rest break policy does not restrict or require an employee to stay on the premises or remain available to answer business operations questions, patient questions or calls. However, if an employee leaves the premises and returns late, disciplinary action can still apply.

The policy should state that the employee should not remain in the work area or take a break in an area where interruptions could potentially occur. In many instances of smaller practices, this could pose a challenge. Ideally, a best practice is to incorporate rest breaks for all employees into the practice schedule each day and discuss during the morning huddle “coverage” among team members.

Management staff and other employees should be trained to refrain from interrupting an employee while he or she is on break. Of course, as interruptions can occur from time to time, the court noted that breaks can be rescheduled, or an employer can pay the penalty. However, this should be the exception, not the rule.

Policies should also state that employees should report to their supervisors the inability to take an interrupted break or when unable to take a break at all.

Rest period policies should include that breaks are free from duty and that scheduled breaks must be taken by each non-exempt employee.

CDA Practice Support has updated its Sample Meal and Rest Break Policy to reflect the new changes. It is available at cda.org/practicesupport.

Employers should incorporate the changes into their practice employee manuals, provide the updated policy to their employees and discuss the changes and expectations. Additionally, they should obtain a signature from each employee acknowledging that they have read and understand the new policy moving forward.

Visit cda.org/practicesupport for the updated “Sample Meal and Rest Break Policy” as well as a “Practice Policy Revision Employee Acknowledgment Template.” Read the court’s opinion on Augustus v. ABM.

Topics: Employment Practices, Laws & Regulations, Office Policies & Manuals

 

Reprinted with permission from the CDA.

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.

The California EPA’s Office of Environmental Health Hazard Assessment has adopted a regulation revising the notices that dental practices are required to post under Proposition 65, known as the Safe Drinking Water and Toxic Enforcement Act. The regulation, which takes effect in 2018, also amends the methods by which dental practices provide the notices.
Passed by voter initiative in 1986, Proposition 65 requires businesses with 10 or more employees to provide “clear and reasonable warning” if a product or business location may expose employees or consumers to a chemical known to the state to cause cancer or reproductive toxicity.
Since 2003, CDA has been providing its member dentists with a specific court-approved notice for dental amalgam and other restorative materials. CDA then began providing a notice for nitrous oxide, which was added to the list of chemicals a few years later, and then a third notice for Bisphenol A (BPA), when that chemical was added to the list in April 2015.
The court-approved notice that CDA proposed has likely spared many dental practices from expensive, private litigation. In the lawsuit leading to the 2003 court-approved settlement, 80 practices had been sued for failure to provide an adequate warning. Additionally, CDA continued to work with regulators and stakeholders to ensure that any Proposition 65 reforms narrowed the scope of the regulation as it applies to dental practices — both to better warn patients about specific, potentially dangerous chemicals and to protect dental practices from frivolous lawsuits.
Now, under the new regulation, dental businesses (such as practices, schools and laboratories) will be required to comply with one of two provisions:
• Post one notice (in lieu of three) “at all public points of entry to the dental office or in each location within the office where an exposure is reasonably likely to occur;” or
• Provide a warning with an informed consent form or as part of an informed consent form signed by the patient prior to exposure.
Dental practices may choose to provide the warnings via both posted notice and informed consent. The notice will direct patients and employees to a website, oehha.ca.gov/proposition-65, for more information about the specific chemicals.
OEHHA relies on expert scientific panels to develop what is now a list of more than 800 chemicals that require warning notices. The governor is required to publish the list at least once a year. Either the Attorney General or private parties can enforce the warning requirement through litigation.
The regulation is effective Aug. 30, 2018. In the interim, to allow for a reasonable transition period, dental offices may choose to comply with either the current regulation or the provisions of the new regulation.
CDA is developing resources, including a revised notice in several languages and an updated FAQ, that dental offices will need to comply with the new regulation by Aug. 30, 2018. CDA will share these resources when they become available in the CDA Update and on cda.org.

 

Reprinted with permission from the CEA.
From the October 2016 issue of
The Nugget.

http://www.employers.org/blog/383-osha-changes-we-ve-been-given-a-bit-more-time
Employers have been given a few more months to comply with the OSHA rules that went into effect on August 10, 2016.
OSHA 81 Fed. Reg. 29624:
– Prohibits mandatory post-accident drug testing. OSHA claims these tests discriminate against employees and make them less likely to report injuries and illnesses.
– Prohibits employers from retaliating against employees who report an injury or illness.
– Requires employers to inform employees about this anti-retaliation rule in writing with a signed acknowledgement form.
While the provisions are still effective August 10, 2016, OSHA has delayed their enforcement until Nov. 1, 2016 in order to provide outreach to the regulated community.
*CEA’s Sample Retaliation policy:
Employees have a right and are therefore encouraged to report any workplace injury or illness. Employees who report workplace illnesses or injuries are expressly protected from retaliation and no adverse action will be taken again employees for doing so. If employees believe that adverse or retaliatory action has been taken, they should immediately report such actions to (HR, Board of Directors, etc) any company official not involved in the complaint.
Source: https://www.osha.gov/recordkeeping/finalrule/index.html

Reprinted with permission from the CEA.
From the October 2016 issue of
The Nugget.

http://www.employers.org/blog/378-read-all-about-it-new-posters-released-august-1st
In case you missed our alert back in July, we thought this notice was worthy enough to repeat.
The Good News – this isn’t going to cost you any money!
The Bad News – you don’t have much time to act!
Effective August 1, 2016, employers must post new Fair Labor Standards Act (FLSA) and Employee Polygraph Protection Act (EPPA) postings.
The Department of Labor has removed penalty amounts from the posters and has added a section about the rights of nursing mothers to the FLSA poster. Employers are required to post the revised versions of these federal posters by August 1, 2016. Once you print out the new postings, place them near or on top of your poster. Or, purchase a new, fully compliant poster.

To download and print a copy of the Minimum Wage Poster  – click here:https://www.dol.gov/whd/regs/compliance/posters/minwagep.pdf

To download and print a copy of the Polygraph Poster  – click here:https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf

To order a New All-in-One Poster from CEA, complete with the new postings, click here:

http://www.employers.org/hr-prod/labor-law-safety-posters


Reprinted with permission from the CDA.
From the October 2016 issue of The Nugget.

Delta Dental has initiated the first of a three-phase mailing to participating dentists as part of the provider directory verification process required by California Senate Bill 137. Hard copy letters were mailed to more than 8,600 dental practices located in various parts of the state, ranging from Alameda to Riverside counties, the first week of August.
Dental practices in the counties listed in the chart below will receive the first-round correspondence from Delta Dental regarding SB 137 compliance…

http://www.cda.org/NewsEvents/Details/tabid/146/ArticleID/3478/Provider-directory-compliance-letters-in-the-mail.aspx


From the October 2016 issue of
The Nugget.

A new ADA member benefit is helping members save thousands by refinancing their dental school loans. DRB’s student loan consolidation/refinancing program, which ADA exclusively endorses, provides ADA members the opportunity to refinance existing federal and private student loans from undergraduate or graduate school at a 0.25% lower rate than DRB’s already low rates.
Visit student.drbank.com/ADA to view rates and apply.

Reprinted with permission from the CDA.
From the October 2016 issue of
The Nugget.

CDA has developed California-specific resources to assist dentists in meeting the Oct. 16 deadline for compliance with the U.S. Department of Health and Human Services’ Office for Civil Rights’ final rule concerning Section 1557 of the Affordable Care Act.
Section 1557, in effect since 2010, is the ACA’s nondiscrimination provision, prohibiting discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. The final OCR rule, issued in May, aims to educate consumers about their rights and help covered entities understand their obligations under Section 1557. (The OCR is actively investigating complaints of discrimination under the provision.)
Dentists participating as providers in the Denti-Cal and CHIP (formerly known as Healthy Families) programs and those provider entities who have received Meaningful Use funding from HHS are required to comply with the new rule.
Dentists must comply with the following elements of the rule by Oct. 16:
• Post a Notice of Nondiscrimination in English in dental practices, on websites and in significant publications or communications.
• Post taglines in the top 15 non-English languages spoken in California offering free language assistance. Post them in dental practices, on websites and in significant publications or communications.
• For offices with 15 or more employees, post information regarding the dental practice’s grievance procedure.
The new CDA resource, “Nondiscrimination Requirements Under the Affordable Care Act (Section 1557),” will help dentists comply with the OCR rule. The resource provides: a detailed background on the ACA provision and new OCR rule; checklist, instructions and recommended practices for dental practices to follow to meet the compliance requirements under the July 18 deadline (see the related story in the August issue of the CDA Update, page 10) and the forthcoming Oct. 16 deadline; sample grievance procedure and notice of nondiscrimination forms; questions and answers; and a list of additional resources… [visit sdds.org or cda.org to read the full article]
CDA will inform its members of any granted deadline extensions or other developments on cda.org and in upcoming issues of the CDA Update. The CDA resource can be downloaded at cda.org/practicesupport

Reprinted with permission from the CDA Practice Support.
From the August/September 2016 issue of
The Nugget.

In May, several thousand HIPAA-covered entities received emails from the U.S. Department of Health and Human Services Office of Civil Rights (OCR) as the agency rolled out Phase 2 of its HIPAA Audit Program. One email asked covered entities to confirm contact information, then, if information was confirmed, covered entities received a questionnaire and were given 30 days to complete it. The number of emails sent was larger than originally anticipated since OCR had previously announced the number of audits they expected to conduct in Phase 2. Now, it appears OCR will move forward with full implementation of its audit program in 2017.

From the returned questionnaires, OCR will randomly choose approximately 200 covered entities to undergo a desk audit. Following the desk audits, an unknown number of business associates identified through the questionnaire also will go through desk audits and other covered entities, plus a few covered entities who completed desk audits, will have on-site audits. All desk audits are expected to be completed by the end of this year. It is likely that some on-site audits will continue into 2017. This is the entirety of Phase 2.

Following Phase 2 is the launch of the full audit program. The audit program was authorized with passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009. It is to be an ongoing program to help OCR assess HIPAA compliance efforts and discover privacy and security risks and vulnerabilities that previous complaint investigations and compliance reviews have not revealed. OCR intends to identify best practices and will provide guidance in areas where covered entities and business associates face compliance challenges. An audit is not an investigation and the assessment of fines and penalties is not part of the audit program. However, if warranted, auditors may recommend investigation of covered entities and business associates.

The audit program focuses on compliance with the HIPAA Privacy, Security and Breach Notification rules. Covered entities selected for a desk audit will be asked to submit specific documentation via a secure web portal. Dental practices should ensure a security risk analysis has been conducted and that required policies and procedures are in place. For example, a dental practice should ensure its Notice of Privacy Practices is dated no earlier than Sept. 23, 2013, when HIPAA amendments became effective, and that it is posted on the practice website. A covered entity selected for a desk audit will have 10 days to submit requested documentation to OCR.

Each audited entity will have an opportunity to review and comment on the draft auditor’s report and to have the comments included in the final report. A protocol for the audit is available online at hhs.gov.
Contact CDA Practice Support with any questions about these audits and HIPAA compliance at 800.232.7645.

Reprinted with permission from the CDA.
From the June/July 2016 issue of
 The Nugget.

A law created by Senate Bill 137 goes into effect on July 1 and requires all health plans to maintain accurate provider directories. This law requires dentists contracted with dental plans to respond to a plan’s request for accurate directory information within 30 days or face payment delays, reimbursement reductions or, ultimately, termination of their participating provider agreement.

As the push toward increased transparency and accountability increases throughout the health care industry, health plans are under increasing pressure to steer enrollees toward contracted providers when seeking treatment to minimize patient out-of-pocket costs. The out-of-pocket difference can be significant to patients when they seek treatment from a provider, only to discover that the dentist listed in the plan directory is no longer contracted with their plan. This law was created to provide patients with more accurate and complete information as to which dentists are contracted with their dental plans and whether those dentists are accepting new patients.

SB 137 places extensive requirements on the dental plans in terms of compliance and penalties. The provider outreach efforts and the technology systems needed to meet directory compliance are both cumbersome and expensive. The plans are expected to modify their current online directories in order to be in compliance by July 1, and then change the directory format again once the standard format is developed and approved later this year by regulators.

For dentists participating as a contracted provider with multiple plans, it is vital that a system is established within the dental practice to ensure dental plan communications and outreach efforts are reviewed and responded to in a timely manner. Recommendations may include a separate email address for tracking plan communications or designating someone in the practice to be responsible for monitoring and responding to dental plan requests.

Failing to respond to the dental plan within 30 days of a request for verification of dental practice information could result in plan reimbursement disruption and provider participation. Additionally, dentists must notify the dental plan within five business days when there are changes in the dentist’s capacity to accept new patients/plan enrollees.

CDA is actively engaged with the dental plans and regulators as they navigate SB 137 compliance and will provide more information to members as soon as it becomes available. For more information, please contact CDA Public Policy at 916.554.4984.

Learn about new provider directory law at CDA Presents

For more specifics regarding this new law, CDA members are encouraged to attend a CDA Presents presentation on SB 137 compliance at The Spot educational theatre in Anaheim at 10 a.m., Saturday, May 14. The presentation titled “Prevent Payment Penalties Under New Provider Directory Law,” will provide an overview of the new provider directory law and its implications to consumers, dentists and dental plans.

Reprinted with permission from the CDA.
From the June/July 2016 issue of
 The Nugget.

A single lot of Sensorcaine, which is often used in the injection for local or regional anesthesia in oral surgery, has been recalled.

The recall was announced by Fresenius Kabi USA after an inspection of reserve samples revealed a particulate could block administration of the drug to the patient. This could cause a delay in therapy, result in local inflammation and mechanical disruption of tissue or immune response to the particulate.

According to a statement, Fresenius Kabi has not received any reports of adverse events related to the recall.

The recalled Sensorcaine product is labeled with “Product Code 470237” and “Lot Number 6111504.” It is supplied as 0.75 percent strength in a 30 mL, single-dose, flint-molded vial and packaged in units of 25. The product was shipped in the U.S. to wholesaler and distributor outlets between March 4, 2016, and March 21, 2016, and has an expiration date of September 2019. The NDC number is 63323-472-37.

Fresenius Kabi is notifying its distributors and customers by letter and is arranging for the return of all the recalled product. If health care facilities have the affected lot, they are to immediately discontinue distributing, dispensing or using the lot and return all units to Fresenius Kabi.

Consumers with questions regarding this recall can contact Fresenius Kabi at 800.551.7176 Monday through Friday, during the hours of 8 a.m. to 5 p.m. or email productcomplaint.USA@fresenius-kabi.com or adverse.events.USA@fresenius-kabi.com.

Health care professionals and patients are encouraged to report adverse events or side effects related to the use of this product to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program by:

Completing and submitting the report online at fda.gov, or

Downloading the form online, or calling 800.332.1088 to request the form, then completing and returning to the address on the pre-addressed form, or submitting by fax to 800.FDA.0178.

Reprinted with permission from the CDA.
From the June/July 2016 issue of
 The Nugget.

A bill requiring the Dental Board of California to review laws regarding general anesthesia for dental care has made its way to the state Senate. CDA currently supports AB 2235 (D-Thurmond), which calls for a dental board review of current laws, regulations, safety statistics and policies to determine whether they are sufficient to protect minor patients from the potential for injury or death during the administration of general anesthesia.
The proposed legislation stems from last year’s tragic death of a boy who had undergone general anesthesia for dental care. The bill originally contained language that inaccurately portrayed the risks associated with general anesthesia and assumed data that has not been substantiated about the safety of dental anesthesia provided under the operator-anesthetist model of care.
The review process currently in the bill provides the opportunity for a comprehensive, substantive approach to address concerns raised by Assembly member Thurmond and ensure that state policies provide the highest level of safety possible. CDA has been actively supporting this evidence-based approach and is committed to supporting legislative or regulatory changes identified through the board’s analysis.
CDA will continue to keep members informed about this issue in the CDA Update.

Reprinted with permission from the CDA.
From the June/July 2016 issue of
 The Nugget.

Assembly and Senate Republican leaders called on Gov. Jerry Brown to make additional funding for Denti-Cal a priority in this year’s state budget. The legislative leaders have put forward a plan to increase funding for Denti-Cal “in a meaningful and responsible way.” Specifically, they are pursuing a commitment of an additional $200 million, which will also pull down federal matching funds.
According to the proposal, the increased funding would go toward raising provider rates to the national average for the most common services to incentive provider participation in the state’s highly criticized dental program, which was recently described in a report from the Little Hoover Commission as one of the state government’s “greatest deficiencies.” The new funding would also be used to increase the emphasis on preventive care, case management services and bringing providers into the program.
“While much work remains to be done to improve the state’s Denti-Cal program, CDA is pleased that the Republican caucuses in both houses are proactively taking on this issue,” said CDA President Ken Wallis, DDS.
Numerous reports over the last several years have consistently highlighted the insufficiencies and dysfunction of the state’s dental program, including reimbursement rates among the nation’s lowest, an abundance of restrictive rules and reliance on outdated paper-based administrative processes.
The most recent report, released by the Little Hoover Commission in March, found that the program consistently falls short in its purpose to provide quality dental care for 13 million low-income Californians, including over 5 million children. The report reveals that “California’s Medicaid dental program is widely viewed, historically, and currently, as broken, bureaucratically rigid and unable to deliver the quality of dental care most other Californians enjoy.”
This report only reinforces the findings of the state’s 2014 audit, which found more than half of the 5.1 million children enrolled in Denti-Cal in 2013 did not receive any dental care and that there is a lack of providers in a number of California counties, including five counties with at least 2,000 children in the program that may not have had any active dental providers.
Given these alarming reports, CDA appreciates the attention Denti-Cal is now receiving and the positive steps being taken to address the program’s deficiencies. Under an agreement the state negotiated at the end of 2015, through the 1115 Waiver, California will receive $740 million in new federal money for prevention, early treatment for children and innovative pilot projects. Additionally, legislation recently introduced — AB 2207 by Assembly member Jim Wood, DDS — streamlines provider enrollment, increases monitoring and reporting requirements and improves care coordination and linkages with MediCal managed care plans.
It is clear that fixing the Denti-Cal program will take a multifaceted approach and additional funding for provider rates must be a part of that solution. The type of funding proposed by California Republicans ultimately comes down to a negotiation with the governor and Democratic legislative leaders through the budget process.
CDA will keep members informed through cda.org and the CDA Update as information becomes available.

Reprinted with permission from the CDA.
From the June/July 2016 issue of
 The Nugget.

All prescribers in California with U.S. Drug Enforcement Administration registrations are required to register by July 1 to access California’s prescription drug monitoring program, known as CURES 2.0 (Controlled Substance Utilization Review and Evaluation System).
Prescription drug monitoring programs are used in most states to aid prescribers and dispensers to identify fraudulent or drug-seeking activity by a patient. Dentists are strongly encouraged to consult CURES when considering a controlled substance prescription for a new patient or a patient suspected of drug dependency.
“Opioid use and deaths attributed to abuse are sharply on the rise across the country, and as dentists, we must do our part to help curb this problem. Making sure you are registered to access CURES 2.0 is part of that,” said CDA President Ken Wallis, DDS.
Prescribers in the U.S. write nearly 100 percent of opioid prescriptions worldwide, and in California alone, more than 1 billion dosage units of hydrocodone combination products were dispensed in the 2013-14 fiscal year. In recent years, government agencies and public health advocates have looked for tools to turn the tide on opioid abuse. The CURES system upgrade and the requirement for prescribers to register by July 1, as well as the recent Schedule II reclassification of opioid combination drugs, are all part of these efforts.
The CURES requirement was established in 2013 (SB 809 DeSaulneir) and directs the DOJ, in conjunction with the Department of Consumer Affairs (DCA) and licensing boards like the Dental Board of California, to develop a streamlined application and approval process to provide access to the CURES database, also known as the California Prescription Drug Monitoring Program (PDMP), for licensed health care practitioners and pharmacists.
Prescribers must have updated browsers to access the CURES 2.0 system. To access CURES 2.0, dentists are required to use Microsoft Internet Explorer Version 11.0 or greater, Mozilla FireFox, Google Chrome or Safari.

To register, visit oag.ca.gov/cures.
For more information on the current science and practice of pain management in dentistry, see the November 2015 Journal of the California Dental Association at cda.org/journal.

Nancy Archibald, DDS
From the June/July 2016 issue of
 The Nugget.

Paychex wanted to meet with me briefly to see if they could offer any more services to me that they provide.

Retirement plan? Nope I have a SAR/SEP with no administration fees ( they don’t make those any more).
HR resource? Nope I have CEA as a member benefit from SDDS.
Training manual/ office policy? Nope, just did my update with…SDDS.
Workmen’s comp? No that would be through CDA , oh, and I get my updated poster free from…SDDS.
Salary surveys? Sorry again. SDDS does one locally, and those who participate get the results for free.
Needless to say, we had a pleasant but short visit.

Just had to share!

Reprinted with permission from the CDA.
From the June/July 2016 issue of
 The Nugget.

Please be aware that for the last several months, licensure renewal notification letters have misprinted the website address for the new online renewal system, BreEZe. The letters list the website with a “.com” at the end, instead of “.ca.gov”

Dentists going online to renew a license must use: www.breeze.ca.gov

The laws governing RDAEF utilization (B&P Code 1753.7) states “A licensed dentist may simultaneously utilize in his or her practice no more than three registered dental assistants in extended functions or registered dental hygienists in extended functions (RDAEF) licensed pursuant to Section 1753 or 1918”.

We focus on the word simultaneous because technically if more than three RDAEFs are employed by each dentist employer, the schedule could be arranged to allow for up to three RDAEFs to perform EF functions, while the other EFs could be performing RDA-only functions on the same day.

This section of statute applies to both RDAEF1 and RDAEF2 licensees.

CDA recently hosted a webinar, presented by the Department of Justice, to assist member dentists with the Controlled Substance Utilization Review and Evaluation System (CURES 2.0) registration process and any questions they may have regarding the new system. For the convenience of CDA members, the recorded webinar, which offers dentists important CURES registration tips, is now available.

All prescribers in California with U.S. Drug Enforcement Administration registrations are required to register by July 1 to access California’s prescription drug monitoring program, designed to aid prescribers and dispensers in identifying fraudulent or drug-seeking activity by a patient. Dentists are strongly encouraged to consult CURES when considering a controlled substance prescription for a new patient or a patient suspected of drug dependency.

To register for CURES 2.0, visit oag.ca.gov/cures.

From the April 2016 issue of The Nugget.

In light of recent burglaries victimizing medical offices in Northern California, specifically targeting credit card terminals, instituting measures to prevent identity theft and fraud is of utmost importance. Some suggestions to aid in preventing such crime include:

  • Removing the credit card terminal from the business at the end of every day
  • Locking the terminal away in a secure location to prevent discovery
  • Applying “password protection” to any terminal to be required for any attempted “refund”
  • Upgrading the terminal to a “self-disabling” device. Such devices require the initial set-up to be conducted every time the terminal loses power and the issuing bank to contacted to have the terminal reassigned to your merchant account
From the April 2016 issue of The Nugget.

Patients may request that the directions on the label of dispensed medication be translated. A new law that went into effect on Jan. 1 now requires that dentists who dispense medication oblige such requests if translated directions are available.

AB 1073 requires prescribers who dispense medication to provide translated directions for use when requested by the patient or patient’s representative. “Dispensing” is not the same as “administering” medicine, and includes writing a prescription for medication. Dispensed medicine is provided to a patient for use outside of the prescriber’s facility.

A dentist who prescribes medication must, upon request, provide translated directions for use on the prescription container, label or on a supplemental document. (An example of directions for use is “Take 1 pill at bedtime.”) The English-language version of the directions for use must also appear on the container or label (not on a supplemental document). The state Board of Pharmacy has translated directions in Chinese, Korean, Russian, Spanish and Vietnamese available online at pharmacy.ca.gov. A dispenser may provide his or her own translated directions or can use the translations made available by the Board of Pharmacy. The dispenser is not obligated to provide translated directions for use beyond the languages that the Board of Pharmacy has made available or beyond the directions that the board has made available in translated form.

State law requires prescribers who dispense medication to comply with the same rules as pharmacies, including the use of “patient-centered” prescription labels that contain specified information in sans serif 12-point type. The Board of Pharmacy provides examples of such labels on its website. Prescribers who dispense also must meet record keeping and patient notification requirements and use childproof containers.

Additional information can be found in articles on cda.org/practicesupport in the “Controlled Substances: Prescribing and Dispensing” and “Medication Prescribing and Dispensing Q-and-A” resources.

From the April 2016 issue of The Nugget.

CDA and the Save Lives California coalition are encouraging dentists across the state to take action by signing a petition to make sure the ballot measure to increase the state’s tax on tobacco products by $2 per pack qualifies for the November ballot.

CDA has delivered petition forms to all local components to help collect signatures. Every signature that CDA members can collect saves vital campaign resources that the coalition will need to counter the tobacco industry.

Each petition form has eight signature lines on it. Three critical points include:

  1. All signatures must be from California registered voters.
  2. All signatures on an individual form must be from residents of the same county, based on the address they are registered under. For example, anyone collecting signatures from people from multiple counties will want to have separate forms with the appropriate county name filled in.
  3. The person collecting signatures must fill out the “circulator” information at the bottom of the form.

Dentists can also take forms to collect signatures from other colleagues, family, friends, etc. The coalition will have until April 26 to collect the required amount of signatures to qualify the “California Healthcare, Research and Prevention Tobacco Act of 2016” for the November ballot. The Save Lives California coalition is working to collect as many signatures as possible through volunteer efforts, and the California Medical Association, American Cancer Society Cancer Action Network, Service Employees International Union, American Heart Association and American Lung Association are all joining CDA in the signature-gathering effort.

The ballot measure will raise California’s tobacco tax, which has not been increased since 1998, by $2 per pack (from 87 cents, which has fallen to 35th in the nation, to $2.87) with an equivalent tax on other tobacco products, including e-cigarettes.

Tobacco use is the No. 1 cause of preventable death in California and raising the tax will help prevent and reduce tobacco use. Ninety percent of smokers start as teens and for every 10 percent increase in the cost of a pack of cigarettes, teen smoking drops by up to 7 percent. The measure will also generate revenue for critical state healthcare programs, prevention and research. Every year, smoking costs California taxpayers billions of dollars, including $3.5 billion that Medi-Cal spends annually to treat smoking-related diseases. In addition to funding for the Medi-Cal/Denti-Cal programs, the measure includes funding for the state’s oral health program overseen by the new state dental director, an unprecedented dedicated funding source for this program.

Dentists should contact their component executive director to sign the petition or legislative chair for more information on how you can help with this process. Dentists can also contact CDA Public Affairs Manager Todd Roberson with any questions at todd.roberson@cda.org or 916.554.4982.

For more information on the Save Lives California coalition, visit savelivesca.com.

From the October 2015 issue of The Nugget.

  1. A patient pays with a suspicious magnetic stripe credit card and the dentist still uses an old non-EMV terminal.
  2. A patient pays with a suspicious EMV credit card and the dentist still uses an old non-EMV terminal.

Replacing a non-EMV terminal with an EMV-compliant terminal protects the practice from fraud liability.  An EMV terminal verifies suspicious EMV credit cards.  The EMV terminal cannot verify suspicious magnetic stripe cards, but since the dentist is using an EMV-compliant terminal, the dentist is protected from fraud liability.

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.

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 April 2015 issue of The Nugget.

Beginning on July 1, 2015, California employers must provide paid sick leave to employees. The Healthy Workplaces, Healthy Families Act (AB 1522) applies to all employers, regardless of size. The law requires either one hour of sick leave for every 30 hours worked or three days of sick leave per year. Employees accrue sick leave upon hire, although they may be restricted from taking earned leave until they have completed 90 days of employment.

The law has raised numerous questions. The California Department of Labor Standards Enforcement (DLSE) recently issued a set of “Frequently Asked Questions” (FAQs) and other guidance that address some of them.

Provisions of the Sick Leave Law Go Into Effect on Jan. 1, 2015
AB 1522 requires employers to provide sick leave beginning July 1, 2015, but does not specify when provisions such as notice requirements go into effect. The DLSE has clarified that employers must display a poster regarding the new law on Jan. 1, 2015.
The DLSE also requires employers to provide a revised “Wage Theft Prevention Act” notice to non-exempt employees hired after January 1, 2015. The notice now includes information about the employee’s entitlement to paid sick leave. Both the poster and revised notice are available on the DLSE’s website.

AB 1522 requires employers to notify employees of the amount of sick leave available on the employee’s wage statement or a separate document. The DLSE does not address whether this notification is required beginning January 1. The safest practice is to include the information on the wage statement before July 1 at the latest; and earlier if the payroll system will accommodate providing the new information.

Eligibility Requirements
The DLSE’s FAQs addresses employee eligibility. All employees who work 30 hours per year or more in California are eligible upon hire, including temporary employees. However, because an employer may restrict employees from taking sick leave until they have worked 90 days, an employee who only works for a short period may never be eligible.

Accrual, Carryover, and Use Requirements
AB 1522 specifies that employers either may provide three days of paid sick leave or accrue one hour of sick leave for every 30 hours worked. The DLSE states that if an employer provides three days of sick leave, it must do so at the beginning of the year. The year commences on July 1, 2015, for current employees, and the employee’s anniversary date for later-hired employees. The DLSE does not state whether an employer can provide three days of sick leave on July 1, 2015 (or the anniversary date), and then provide three additional days on an alternate, uniform, date, such as January 1 of each year, to simplify the administrative burden of tracking individual employee entitlement to leave.

The DLSE points out in its guidance that an employee working full-time could accrue a little over eight days of sick leave per year, even though the employee could be limited to using three days per year. However, the law permits employers to cap earnings at 48 hours. An employer that wants to limit accrual to 48 hours should so state in its policy.

Rate of Pay
AB 1522 states that employees must be paid sick leave at their “hourly wage.” The law does not address how to calculate this amount when, for example, employees earn different hourly wages. The DLSE FAQs state that sick leave must be paid at the “regularly hourly rate,” taking into account various forms of compensation such as commissions. The DLSE intends to require employers to pay employees sick leave at the “regular rate” required for calculating overtime. For employees with fluctuating pay, the employer must divide the total compensation for the previous 90 days by the number of hours worked, and pay that rate.

PTO
Employer PTO policies may satisfy the sick leave obligation, but the option may not be attractive for all employers. 1522 states that sick leave need not be cashed out at the termination of employment. Employers are legally obligated to cash out unused PTO, however. Also, employers may not wish to pay PTO at the “regularly hourly rate,” as required for sick leave (according to the DLSE). Finally, PTO plans often apply only to certain employees, requiring employers to expand the benefit to temporary and other employees.
The DLSE FAQs make clear that an employer may have different policies for different employees, as long as all meet the legal requirements. Thus an employer with an existing PTO policy may decide to meet the sick leave obligation for employees who are already eligible for the benefit, but provide an alternate sick leave policy for employees who are not.

Other Laws
The DLSE guidance does not address the application of multiple sick leave laws. For example, it does not explain how employers should integrate the sick leave law requirements with “kin care” requirements or leave requirements under the Pregnancy Disability Leave law or California Family Rights Act.

The guidance also does not address how employers subject to local sick leave ordinances comply with both those ordinances and the state law. For example, Oakland recently enacted a sick leave ordinance that is similar to AB 1522, but has different accrual maximums and use requirements. It is not clear whether these benefits run concurrently with, or in addition to, sick leave provided under AB 1522.

Conclusion
The DLSE’s guidance helps clarify some ambiguities in AB 1522. But many compliance issues remain unresolved. More guidance may be forthcoming. However, employers must now comply with the new law’s requirements and prepare for the July implementation.

This article was originally published by the CDA on cda.org.

CDA reminds dentists who write controlled substance prescriptions that they must ensure their tamper-resistant forms are up-to-date.

CDA has learned prescriptions are being rejected by pharmacies because the forms do not include all of the required elements.

One of those required elements is that tamper-resistant forms used for controlled substance prescriptions must have the prescriber’s address preprinted on them. This requirement was put into law in January 2012, although the old prescription forms could be accepted through June 30, 2012.

If it has been some time since ordering new prescription forms, dentists should make sure the following is preprinted on the forms they are currently using:

  • Prescriber’s name and address.
  • Category of licensure and license number.
  • Federal controlled substance registration number (DEA number).
  • The statement, “Prescription is void if the number of drugs prescribed is not noted.”
  • Six quantity check-off boxes next to the following numbers: 1-24; 25-49; 50-74; 75-100; 101-150; 151 and over.
  • A space next to the quantity boxes for the prescriber to designate the units referenced in the quantity boxes when the drug is not in tablet or capsule form.
  • Check boxes for the prescriber to indicate the number of refills ordered.
  • A place to indicate the prescription’s date of origin, which must be hand written.
  • A check box indicating the prescriber’s order not to substitute.
  • An identifying number assigned to the approved security printer by the Department of Justice.
  • A check box by the name of each prescriber when the form lists multiple prescribers (the prescriber signing the form must check the box next to his or her name).
  • A number for each batch of forms, with each form in a batch numbered sequentially beginning with the number one.

Dentists can purchase tamper-resistant prescription forms only from state-approved printers. A list of approved printers is on the Department of Justice’s website. Printers require photo identification from a customer who personally picks up the forms, and only established customers may pick up the forms in person. If mailing the forms to a prescriber, the printer must use certified mail or other means that requires the recipient’s signature, and must send the forms to the prescriber’s address that is on file with the DEA.

More information on applicable state and federal laws is available in the “Controlled Substances Prescribing and Dispensing” resource on cda.org.

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.

Reprinted with permission from CDA. 

Dentists have until March 1 to report a HIPAA-compliance issue to the U.S. Department of Health and Human Services Office for Civil Rights (HHS).

Specifically, HIPAA-covered practices must report any breach of its electronic patient information that may have affected fewer than 500 people by that date. Breaches that may have affected more than 500 people have more strict timelines as practices only get a 60-day window to report the incident.

According to the HHS, “A covered entity’s breach notification obligations differ based on whether the breach affects 500 or more individuals or fewer than 500 individuals. If the number of individuals affected by a breach is uncertain at the time of submission, the covered entity should provide an estimate, and, if it discovers additional information, submit updates in the manner specified below. If only one option is available in a particular submission category, the covered entity should pick the best option, and may provide additional details in the free text portion of the submission.”

The HHS website allows for dentists to report an incident electronically and has instructions for submitting.

The breach notification rule was approved in 2009 as part of a larger set of HIPAA amendments known as the Health Information Technology for Economic and Clinical Health Act (HITECH). Congress passed HIPAA in 1996 to simplify, and thereby reduce the cost of, the administration of health care. HIPAA does this by encouraging the use of electronic transactions between health care providers and payers, thereby reducing paperwork. 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.

Secure electronic transmission of protected health information is one of the many requirements of the HIPAA Security Rule. Dental practices should review the rule requirements to ensure compliance. A major component of compliance is a documented risk analysis. HIPAA Security Rule: A Summary can be found on cda.org. HHS has on its site a Guidance on Risk Analysis.

CDA has a Data Breach Notification Checklist on cda.org/practicesupport. The ADA Practical Guide to HIPAA Compliance includes information about the HIPAA Breach Notification Rule.

For more information, visit cda.org/privacy-hipaa.

The Sacramento District Dental Society has been named an Exceptional Organization by the Del E. Webb Foundation (DEWF). The DEWF Board of Directors went through their records for the past 10 years and found 22 exceptional organizations out of the 1,024 they had dealt with in that time. All these organizations “have at least one grant unanimously approved by all DEWF board members, have outstanding management and leadership commitment, provide consistent excellent service to a great many people and make excellent use of the funds received.”

By Kim Parker, CEO, California Employers Association 

The Healthy Workplace, Healthy Families Act of 2014 (AB 1522) was signed into law in 2014.
The basic intent of the law is to provide all employees with at least three days or 24 hours of paid sick leave each year.

What does this mean for you as an employer?
Effective January 1, 2015 ALL employers must post a Paid Sick Leave Notice in their place of business. Effective July 1, 2015, all employers, both public and private, will be required to provide paid sick leave to all of their employees, with a few exceptions (unionized workers, home health care providers and airline flight crews).

What does AB 1522 mean for employees?
Under AB 1522, all employees who work in California for 30 or more days in a calendar year, will earn paid sick leave at a rate of one hour for every 30 hours worked! This accrual method begins as of 7/1/15 and employees must be allowed to use any accrued time after 90 days of employment. (Former employees that are re-hired within one year are entitled to have previously accrued and unused paid sick days be reinstated.)

Employers will be allowed to limit an employee’s use of paid sick days to three days per year and can cap accrual of paid sick leave at six days.

Another option to the accrual method described above is to give employees all of their paid sick leave up front. This has been called “front loading” “the lump sum method” or “granted leave”. In each case, employers are permitted to grant three or more days of paid sick leave at the start of the year to their employees to avoid the administrative burdens of tracking accrual and carry over.

When can employees use AB 1522?
Employees can use AB 1522 to take paid leave for themselves or a family member for preventive care or care of an existing health condition or for specified purposes if they are a victim of domestic violence, sexual assault or stalking.

Family members include the employee’s parent, child, spouse, registered domestic partner, grandparent, grandchild, and sibling. Preventive care would include annual physicals or flu shots. For partial days employers can require leave be taken in two hours increments, but otherwise the determination of how much time is needed is left to the employee.

Existing law already requires employers that provide paid sick time to allow employees to use half of their yearly allotment for “kin care” (care of their sick child, parent, spouse, registered domestic partner). The new law does not repeal “kin care” but expands it to include grandparents, grandchildren and siblings.

Employers with more generous plans will have to allow employees to use half of the annual sick leave entitlement for Kin Care.

Posting, Notice and Record Keeping Requirements
In addition to accounting for and providing the accrued leave, employers are required to:

  • Display a Paid Sick Leave Poster as of Jan. 1, 2015
  • Include the amount of paid sick leave accrued on employees’ itemized wage statements
  • Retain all paid sick leave records for three years
  • Use the revised Wage Theft Prevention Act Notice on or before July 1, 2015

What if I already provide paid sick leave for my employees?
California employers who already provide at least three days of paid sick time, will now have additional administrative requirements, including:

  • Recording an employee’s sick leave balance on itemized wage statements, or another writing, on each pay day.
  • Carry-over of accrued sick leave with the cap of six days.
  • Documentation showing hours worked as well as paid sick days accrued and used by an employee.

Rate of Pay
Employees should be paid their regular rate of pay for sick leave. However, if your employee is paid different hourly rates, is paid a commission, is paid by piece rate or flag rate, etc. then you must “Divide employee’s total wages, not including overtime premium pay, by the employee’s total hours worked in the full pay period of the prior 90 days of employment” to determine an hourly rate to be paid for sick leave.

What’s the good news?
Employers are not required to pay out accrued sick time at termination. CEA can assist you in developing a Paid Sick Leave Policy that fits your company’s needs. By July 1, 2015 you will be informed and ready to address this new law with your employees and in your employee handbook.

10/08/14

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.” 

Reprinted with permission from the California Employers Association

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

  • Expands the rights and responsibilities under the California Whistleblower 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 changes are coming!
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 http://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.