As the Dental Board of California continues to navigate its first full renewal cycle for the newly established anesthesia and sedation permits, two new implementation issues have been identified for the moderate sedation permit and have prompted CDA advocacy.

Dentists and other health care practitioners in California who issue 100 or fewer prescriptions in a calendar year could receive an exemption from the state’s existing law requiring practitioners to electronically prescribe all medications. 

New dentists have a lot to juggle and think about after graduating from dental school – one of the things that shouldn’t fall through the cracks is making sure they have the proper permits to dispense controlled substances and administer conscious sedation.

When dentists become licensed, they automatically have the ability to write prescriptions for antibiotics, fluoride and other non-controlled substances such as Ibuprofen. When it comes to prescribing, dispensing and administering controlled substances, however, they must first register with the U.S. Drug Enforcement Administration. (Separate registration in California is not required.)

Any dental practice that is uncertain if is fully compliant with HIPAA and state privacy laws will benefit from four new HIPAA training resources available in the CDA Practice Support section of cda.org. Each resource is intended to train both the privacy officer and the security officer in a dental practice on their shared responsibilities.

When performing procedures on exposed dental pulp, water or other methods used for irrigation must be “sterile or contain recognized disinfecting or antibacterial properties,” according to a new requirement that all licensed dentists in California must follow beginning Jan. 1, 2019.

Many bills were introduced over the past year to combat the opioid epidemic in California, as CDA previously reported. Here is an overview of CDA-supported legislation in the areas of e-prescribing, informed consent, interstate data sharing and prescription-pad requirements, that Gov. Jerry Brown signed into law in September and how these bills will affect the practice of dentistry.

Dentists who are purchasing or starting a practice or making a change to their business structure should be aware of a new IRS requirement. As of May 13, 2019, only individuals with a tax identification number — either a Social Security number or an individual taxpayer identification number — may request an employer identification number.

A new safety needle is on the market and is now the fifth safety needle, or safety sharp, available to California dentists. Dental practices that do not use safety sharps should evaluate the NopoGuard as part of the Cal/OSHA-required documentation.

A new safety sharps product, the Verena Solutions SimpleCAP, is available to dentists and can be purchased from most major suppliers. Dental practices are required by the Cal/OSHA bloodborne pathogens regulation to regularly evaluate the appropriateness of using safety sharps with the goal of reducing needlesticks and other “sharps” injuries that can cause exposure to bloodborne pathogens.

Military families will be eligible for Paid Family Leave benefits beginning Jan. 1, 2021. Dental practice owners are encouraged to update their employee handbooks regarding military exigency and Paid Family Leave benefits.

Dentists who have hired an out-of-state-trained dental assistant and would like to enable that assistant to become a licensed RDA in California now have a simplified resource to help with that process. The new resource, available at cda.org/practicesupport, clearly defines the two paths that a dental assistant can follow to become a California-licensed dental assistant.

Dentists have reported to CDA that pharmacies have rejected their prescriptions due either to forms that are out of date or are missing required elements. All prescriptions have been for controlled substances, which must be on tamper-resistant forms printed by California-approved printers and containing California-specific pre-printed elements.

California-licensed pharmacists, dentists and others who dispense controlled substances must follow revised reporting requirements beginning Jan. 1, 2022. Those requirements are different than the requirements for prescribing or administering controlled substances.

A dentist who writes controlled substance prescriptions can now review CURES (Controlled Substance Utilization Review and Evaluation System) for patients for whom the dentist is listed as a prescriber. This ability to review the list is useful when a dentist has misplaced a prescription pad or has had a prescription pad stolen or when a dentist suspects someone is misusing their DEA number.

No later than Aug. 30, 2018, dental practices that employ 10 or more employees must post at the entrance of the office the new Proposition 65 warning notice, unless the practice chooses instead to provide a warning with an informed consent form. The form must be signed by the patient prior to exposure to the chemicals regulated by Proposition 65.

Some hospitals in the U.S. have stopped the practice of covering patients’ reproductive organs during radiographic examinations, but CDA reminds dentists that current state regulation requires that protective aprons be used during dental radiography. The move by hospitals follows an April 2019 recommendation by the American College of Radiology and other medical groups, Kaiser Health News reported last month.

A new CDA Practice Health Check can help dental practices prepare for the American Dental Association’s CDT code changes for 2022. The ADA updates CDT codes annually, and failure to review the changes could lead to unnecessary claim denials and delays. 

On May 24, 2018, the Registered Dental Assistant Written and Registered Dental Assistant Law and Ethics examinations are expected to launch as a single combined exam. The Dental Board of California and the Dental Assisting Council in a December 2016 meeting agreed to take this action to “ensure that the combined examination is legally defensible and meets the requirements of Business and Professions Code Section 139.”

Workers in California dental offices are no longer required to quarantine after a close-contact exposure with someone who has COVID-19 if the exposed worker is asymptomatic and does not test positive, according to updated state guidance.

The ordered closure in mid-December of a children’s dental clinic in Southern California reminds dental practices of the importance of cleaning and maintaining dental unit water lines for the safety of patients. CDA urges dentists to ensure they are following the Dental Board of California’s current requirements along with CDC recommendations.

Most dental facilities that have not installed an amalgam separator to comply with a rule published in June 2017 by the Environmental Protection Agency must install an amalgam separator by July 14, 2020. CDA Practice Support’s resource “Amalgam Separator Requirement — Q&A” was recently updated to reflect recent developments and can assist members with compliance.

Several dentists have notified CDA Practice Support or their local dental societies of two scams targeting their dental practices. Dentists in the San Francisco Bay Area, South Lake Tahoe and Central Valley report receiving calls from individuals who claim to be DEA agents, provide badge numbers and proceed to make demands. The callers tell the dentists they could be arrested if the demands are not met.

Nearly one year has passed since California dentists and other health care providers began electronically prescribing all medications in compliance with state law. Hopefully, processes have been much more efficient for you and your patients, but don’t wait to evaluate your options.
 

Beginning June 1, the National Supplier Clearinghouse began sending letters to Medicare-enrolled dentists notifying them that a surety bond of at least $50,000 per office location may be required to initiate or continue their Medicare enrollment as a supplier of durable medical equipment, prosthetics, orthodontics and supplies. Prior to 2019, dentists were exempt from this rule.

Dentists have an ethical and legal obligation to do no harm and to protect the health of their patients. But what happens when their patients put others at risk? Such is the dilemma faced by some practice owners who have called The Dentists Insurance Company’s Risk Management Advice Line with questions regarding their obligation to treat unvaccinated patients. At the core of this dilemma is the return of a disease previously believed to have been eliminated: measles.