Are You in Compliance?

June 14, 2027: Replace Amalgam Separators
Dental facilities with amalgam separators on June 14, 2017 must replace that separator by this date and comply with documentation requirements. Separators must be compliant with either the American National Standards Institute (ANSI) American National Standard/American Dental Association (ADA) Specification 108 for Amalgam Separators (2009) With Technical Addendum (2011) or the International Organization for Standardization (ISO) 11143 Standard (2008) or subsequent versions so long as that version requires amalgam separators to achieve at least a 95 percent removal efficiency.

January 1, 2022: Comply with new permit requirements for general anesthesia, moderate sedation and minor sedation
SB 501 established new requirements for dentists administering or ordering the administration of general anesthesia, deep sedation and minimal sedation. The new requirements are expected to become effective Jan. 1, 2022. Review a summary of those requirements in Sedation and Anesthesia Permits.

January 1, 2022: E-prescribing required with limited exceptions
More information to come

January 1, 2021: The Paid Family Leave benefits expanding
The program is expanding to offer benefits to any employee who takes time off to attend to situations (qualifying exigencies) related to the covered active duty status of the employee’s spouse, registered domestic partner, child or parent who is a member of the U.S.
Armed Forces. This new law does not create a right to take a protected leave of absence, merely the ability to collect PFL benefits (after Jan. 1, 2021) if the employee does take the time off.

July 14, 2020: Install Amalgam Separators
Dental facilities without amalgam separators on June 14, 2017, with exceptions, must install an amalgam separator by this date and comply with documentation requirements. Separators must be compliant with either the American National Standards Institute (ANSI) American National Standard/American Dental Association (ADA) Specification 108 for Amalgam Separators (2009) With Technical Addendum (2011) or the International Organization for Standardization (ISO) 11143 Standard (2008) or subsequent versions so long as that version requires amalgam separators to achieve at least a 95 percent removal efficiency.

January 1, 2020: Expanded Sexual Harassment Prevention Training requirements for employers of five or more employees
Employers with at least five employees must provide: (1) at least two hours of sexual harassment prevention training to all managerial employees; and (2) at least one hour of sexual harassment prevention training to all non-managerial employees in California by January 1, 2020. SB 1343

August 21, 2019: Hazardous pharmaceutical waste prohibited from disposal down the drain
EPA’s newest rule requires healthcare facilities and other businesses that generate pharmaceutical hazardous waste to properly dispose of the waste. The first part of the rule, the prohibition on “sewering” hazardous pharmaceutical waste, is effective August 21. All nonhazardous pharmaceutical waste that are not controlled substances must be disposed as regulated medical waste. See Dental Office Waste Management Options.

July 1, 2019: New minimum wage requirements and increases for some cities
The following cities and county will increase their minimum wage on July 1: Alameda, Berkeley, Emeryville, Fremont, City of Los Angeles, County of Los Angeles (unincorporated areas only), Malibu, Milpitas, Pasadena, San Francisco, San Leandro and Santa Monica. Check local city websites for wage and notice requirements.

Effective April 1, 2019: The DFEH has released a new notice.
Employers are required to post the updated and renamed Family Care and Medical Leave and Pregnancy Disability Leave notice (DFEH-100-21 / March 2019). Formerly known as, the Family Care and Medical Leave (CFRA Leave) and Pregnancy Disability notice. Effective April 1, 2019, California employers covered by the California Family Rights Act (CFRA) and the NPLA are required to post this new notice. Employers with 20 to 49 employees will need to post the Family Care and Medical Leave and Pregnancy Disability Leave notice in their workplace, and employers with 50 or more employees will need to replace their existing notice with the new version.

March 12, 2019: Transition period to new controlled substances prescription forms
Prescribers of controlled substances may use 2018-compliant prescription forms as well as prescription forms with serial numbers through the end of 2020. SB 149 provides a transition period to new prescription forms that will be required starting January 1, 2021. The legislation, which became effective as soon as it was signed by the governor, resolves the unintended issues created when AB 1753 became effective Jan. 1, 2019. The effective date of AB 1753 left prescribers with very little time to order new forms and it was learned that the format of the serial number did not conform to industry standards. Prescribers in need of new controlled substance prescription forms should ensure they order from an approved printer listed on the DOJ website. New prescription forms with serial numbers formatted in the manner prescribed by SB 149 may be available by 2020. Consider moving to e-prescribing for controlled substances.

January 1, 2019: Warning notice required on opioid container
SB 1109 requires a warning notice be prominently displayed on the label or container of an opioid dispensed to a patient for outpatient use. The notice must state: "Caution. Opioid. Risk of overdose and addicition." The law requires the notice be displayed "by means of a flag or other notification mechanism attached to the container."

January 1, 2019: Mandatory opioid prescription discussion with minor or minor’s parent
Beginning Jan. 1, 2019, a prescriber is required to discuss the following with a minor or the minor’s parent or guardian before issuing the first opioid prescription in a single course of treatment:

  1. The risks of addiction and overdose associated with the use of opioids.
  2. The increased risk of addiction to an opioid to an individual suffering from both mental and substance-abuse disorders.
  3. The danger of taking an opioid with benzodiazepine, alcohol or another central nervous system depressant.

A new informed consent form, Consent to Prescribe Opioid to a Minor, (Spanish version) has been developed and is available on the TDIC and CDA Practice Support websites.

Jan. 1, 2019: Prescriber obligation to prescribe and educate on naloxone use
As of Jan. 1, 2019, a prescriber must offer to a patient a prescription for naloxone hydrochloride or other FDA-approved drug for the complete or partial reversal of opioid depression when one or more of the following conditions are present:

  1. The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day. (See this CDC document on how to calculate MME.)
  2. An opioid medication is prescribed concurrently with a prescription for benzodiazepine.
  3. The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.

Additionally, a prescriber must provide education to a patient, or the patient’s guardian if patient is a minor, receiving a prescription per the above circumstance on overdose prevention and the use of naloxone hydrochloride or other FDA-approved drug for the complete or partial reversal of opioid depression.  AB 2760

January 1, 2019: New infection control standard for procedures that expose dental pulp
When performing procedures on exposed dental pulp, water or other methods used for irrigation must be “sterile or contain recognized disinfecting or antibacterial properties.” 

January 1, 2019: Implement new minimum wage increases
The minimum wage for a large employer with 26 or more employees in California will increase from $11 per hour to $12 per hour, and employers with 25 or fewer employees will increase from $10.50 per hour to $11 per hour on Jan. 1, 2019. Some cities and counties have their own ordinances beyond what is required by state law, with more expected to follow. CDA provides a guide to minimum wage ordinances by city and county and employers are advised to check with their local jurisdictions to ensure they are in compliance.

January 1, 2019: Updated Lactation Accommodation location requirements
Section 1031 of the Labor Code has now been updated to specify that employers should provide a location other than a bathroom. Employers must make reasonable efforts to provide the employee the use of a room, other than a bathroom, in close proximity to the employees work area to express milk in private. Employers should update their employee policy to reflect the new
lactation accommodation requirements. Sample Employee Manual

January 1, 2019: Amendments to clarify ambiguities to salary history ban law
The new law amends the Labor Code to specify that an employer may now ask for an applicant’s salary expectations for the position being applied for, only external applicants (not current employees) and are entitled to request a pay scale for the position they are applying for, but
only after completing an initial interview. The pay scale provided only needs to include salary and hourly wage ranges. AB 2282

January 1, 2019: Update standard mileage reimbursement rate for 2019 (released by Internal Revenue Service)
See the IRS’s press release. For business expense reimbursement, the 2019 rate is $0.58 per mile. That’s up $0.035 from last year.
California employers need to reimburse such common expenses as work-related travel, dining expenses and mileage when an employee uses a personal car for work-related business. However, employees who can prove they spend more than $0.58 per mile to operate their personal vehicles for business use may be entitled to reimbursement of the actual expense.  It’s up to the employees to prove their expenses, however.

Jan. 1, 2019: Enroll in or opt out of Medicare
Dentists who order or provide Medicare-covered items and services (clinical laboratory services, imaging services or durable medical equipment, prosthetics, orthotics and supplies) will need to either enroll in Medicare using form CMS-855-I (PDF) or the shorter enrollment form CMS-855-O (PDF) or formally opt out of Medicare by Jan. 1, 2019. To assure one's status with Medicare and that patients' Medicare benefits do not lapse, dentists should allow sufficient time for processing whichever form is submitted. Learn more about enrollment requirements by visiting the ADA’s Facts and FAQ on Medicare.

October 2, 2018: Mandatory checks in CURES take effect
As announced by the Department of Justice in April 2018, California’s Controlled Substance Utilization Review and Evaluation System (CURES 2.0) is ready for statewide consultation by prescribers. As of Oct. 2, 2018, prescribers must check a patient’s prescription history in CURES 2.0 before prescribing a Schedule II-IV substance, with some specific exceptions. Refer to CDA’s article on mandatory checks for information on the exception applicable to some dentists. Prescribers who have issues accessing CURES can email the DOJ or call 916.210.3187.

Aug. 30, 2018: Replace three Prop. 65 signs with single sign
Proposition 65 regulations were amended in 2016, requiring dental practices to replace multiple notices with one notice or provide the warning as part of the written informed consent. A dentist employing 10 or more employees and using one or more of the chemicals on the Proposition 65 list must provide a warning notice. CDA strongly encourages dental offices with fewer than 10 employees to post the sign or use the warning notice, because the definition of employee is broad and dentists should err on the side of caution. The new regulation is effective Aug. 30, 2018. However, dental practices may choose to comply with the new regulations now and they will be considered in compliance. The posting of the old Proposition 65 warning notices for restorative materials, nitrous oxide and bisphenol A is deemed compliant until the effective date of the new regulation. CDA has developed a Proposition 65 FAQ that includes frequently asked questions and Prop. 65 notices in numerous languages.

July 2018: Notice to Employees: Employment Development Department – Unemployment Insurance, State Disability Insurance, Paid Family Leave (DE 1857A)
The EDD released this new, mandatory posting on July 3, 2018 although the revision date is May 2018. EDD states that, while maintaining updated publications is always encouraged, employers can continue to use the previous version of their mandatory employer notice (DE 1857A) until January 1, 2019—at which time all employers must post the updated version.

July 2018: California Law Prohibits Workplace Discrimination and Harassment / DFEH-E07P-ENG / formerly DFEH-162 (Department of Fair Employment and Housing).
The DFEH has stated that the change to this poster made in June 2018 is not a mandatory update.

July 1, 2018: New minimum wage increases effective 7/1/2018
Belmont, Emeryville, Los Altos, City and County of Los Angeles, Malibu, Milpitas, Pasadena, San Francisco, and Santa Monica. Redwood City has joined the list of cities with a new $13.50/hour increase effective 1/1/2019.

February 15, 2018: Implement New Tax Withholding Tables
On Jan. 11, 2018, the IRS issued revised tax withholding tables for employee paychecks. To comply with IRS Notice 1036, employers should implement the 2018 withholding tables as soon as possible, but no later than Feb. 15, 2018. The notice provides early release copies of the new percentage method tables for income tax withholding. To learn more about your tax responsibilities as an employer, refer to Publication 15 and recent developments at irs.gov.

January 1, 2018: Display New Mandatory Poster on Transgender Rights
California recently passed a new law SB 396 that requires all California employers to post a “Transgender Rights in the Workplace” poster starting January 1, 2018. The new poster must be displayed along with other mandatory workplace notices in a prominent and accessible location in the workplace. View, download and print the Transgender Rights in the Workplace poster provided by the Department of Fair Employment and Housing.

November 1, 2017: Post Safety and Health Notice
The Division of Occupational Safety and Health under the California Department of Industrial Relations, commonly known as Cal/OSHA, has updated the Safety and Health Protection on the Job notice with a poster print date of October 2017. All employers are required to print and post this notice in an area frequented by employees where it may be easily read during the workday.

October 1, 2017: City of Berkeley Minimum Wage and Paid Sick Leave changes
For all employers in the city of Berkeley, Calif., minimum wage increases to $13.75 and increased paid sick leave requirements also become operative effective Oct. 1, 2017. Detailed information and posting requirements about minimum wage requirements can be found on the City of Berkeley’s website. As part of paid sick leave requirements, covered employees accrue one paid sick leave hour for every 30 hours worked; the ordinance is silent with regard to front-loaded allowances. For small businesses, which employ fewer than 25 employees, there is a cap of 48 hours per year; for all other businesses, the cap is 72 hours, though employers can set a higher cap or no cap. Accrued but unused leave carries over from year to year — whether calendar or fiscal year — but cannot exceed the cap. Employers who don’t meet the minimum requirements may still be required to update their written paid sick leave policies.

Sept. 18, 2017: Employers must use revised I-9 form
Beginning Sept. 18, employers must use the revised I-9 form with a revision date of 07/17/17 N. From July 17–Sept. 17, they are permitted to use the previous form with a date of 11/14/16 N. The new version brings very subtle changes to the form’s instructions and a list of acceptable documents, which were created with the goal of making the form easier to navigate. Current storage and retention rules have not changed. Visit the United States Citizenship and Immigration Services website at uscis.gov/I-9.

July 14, 2017: Install Amalgam Separators
With some exceptions, new dental facilities opened on or after June 14, 2017 (does not include purchase of existing dental facility) must install an amalgam separator by this date and comply with documentation requirements. Separators must be compliant with either the American National Standards Institute (ANSI) American National Standard/American Dental Association (ADA) Specification 108 for Amalgam Separators (2009) With Technical Addendum (2011) or the International Organization for Standardization (ISO) 11143 Standard (2008) or subsequent versions so long as that version requires amalgam separators to achieve at least a 95 percent removal efficiency.

July 1, 2017: Provide notice of protected leave for domestic violence, sexual assault or stalking
Under AB 2337, California employers with 25 or more employees must provide written notice to employees of their rights to take protected leave for domestic violence, sexual assault or stalking. The notice should be provided to new employees and to other employees by request. The notice can be downloaded from the Department of Industrial Relations.  

July 1, 2017: Mandatory paid sick leave in the City of Los Angeles
PSL law will apply to employers with 25 or fewer employees as of July 1, 2017. The Los Angeles PSL ordinance contains different provisions than the state PSL law; employers within the city limits must comply with both state and local law. For each provision, protection or benefit, employers must provide whichever is more generous to the employee. Employers must also update their PSL policies accordingly.

May 2, 2017: Updated Wage Order released
The California Department of Industrial Relations (DIR) has updated Wage Order 4-2001 to reflect the 2017 and 2018 increases in the state minimum wage. The DIR amended sections 4(A) and 10(C), which also reflect updated meal and lodging credit amounts. The correct industry Wage Order bears a revision date of “12/2016,” which is found on the bottom of the cover page for each Wage Order. Although the Wage Orders are dated 12/2016, they were just released by the DIR. Please note: this change comes after the 2017-18 CDA Required Poster Set printing. Each employer/practice owner is required to print and post the updated Wage Order over the top of the old Wage Order contained in the Required Poster Set. The Required Poster Sets will not be reprinted to reflect this change until the next print cycle in 2019.

March 6, 2017: Register with CURES 2.0
CURES 1.0 will be discontinued on March 5, 2017, meaning prescribing health care practitioners will only be able to access CURES 2.0. The change stems from security concerns, so practitioners will need to update their browsers accordingly.

March 1, 2017: New all-gender single-stall restroom signage required
Effective March 1, 2017 all single-occupancy restrooms in any business establishment, place of public accommodation, or government agency need to be identified as "all gender" and be universally accessible. The bathrooms to which this law applies are toilet facilities with no more than one water closet and one urinal and with a locking mechanism controlled by the user. Therefore, employers and practice owners should change signage used for single-user restrooms to comply with the law. It is important to note that not every “all-gender” sign available for purchase complies with California law. The state requires the all-gender sign to have a geometric symbol on the door that is an equilateral triangle superimposed onto a circle. No other pictogram, text, or braille is required on the symbol. Additional information is found in the Department of the State Architect Bulletin on the California Building Standards Commission website.

Jan. 21, 2017: Employers must use updated Form I-9  
Practice owners who are hiring or planning to hire new employees must use the new Employment Eligibility Verification Form I-9. As of Jan. 21, 2017, all previous versions of the form will become invalid. The new form is designed to be easier to use. It clarifies several points of confusion for employers, and includes embedded instructions for completing fields. The new form can be accessed via the U.S. Citizenship and Immigration Services website.

Jan. 1, 2017:  Use updated informed consent forms
Written informed consent forms for the sedation/anesthesia of a minor patient must now include specific language. CDA has updated the forms to reflect the change. The language is as follows: “The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.”

Jan. 1, 2017: Use revised CDT codes
CDT 2017 is the newest version of the American Dental Association’s code on dental procedures and nomenclature. Dentists must now use the new dental codes. There are 11 new procedure codes, 5 code revisions and 1 code deletion.

Jan. 1, 2017: Register to file and pay with EDD
Employers with 10 or more employees must register with the Employment Development Department's e-Services for Business and file all wage reports and employment tax returns and pay all contributions for unemployment insurance premiums electronically. All employers will be required to register and file under this new law beginning Jan. 1, 2018.

Jan. 1, 2017: Implement new minimum wage
The minimum wage for a large employer with 26 or more employees in California will increase from $10 per hour to $10.50 per hour, and employers with 25 or fewer employees will remain at $10.00 until Jan. 1, 2018. Some cities and counties have their own ordinances beyond what is required by state law, with more expected to follow. CDA provides a guide to minimum wage ordinances by city and county and employers are advised to check with their local jurisdictions to ensure they are in compliance.

Dec. 22, 2016: Changes to employee rest period
Due to a recent California Supreme Court decision, employees must now be relieved of all duties for their two 10-minute paid break periods to be considered lawful. 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 while on break. Use Sample Meal and Rest Break Policy to update employee manuals and Practice Policy Revision Employee Acknowledgment Template when informing staff of policy changes.

Oct. 18, 2016: ACA 1557: Post nondiscrimination notices and submit Assurance of Compliance Form
Under the Affordable Care Act, dentists participating as providers in the Denti-Cal, Medicare Advantage and CHIP (formerly known as Healthy Families) programs and those who have received Meaningful Use funding are required to comply with new federal nondiscrimination policies. They must post a notice of nondiscrimination, post taglines in the top 15 non-English languages spoken in California and offer free language assistance, and post information regarding grievance procedures for practices with 15 or more employees. Also, they must complete and submit the Assurance of Compliance Form (HHS 690) to the Office of Civil Rights. The form may also be reviewed and electronically submitted through this website.

Aug. 1, 2016: Display new minimum wage posters
Dental practices must post the revised Fair Labor Standards Act (FSLA) Minimum Wage Poster, no smaller than 11 inches by 17 inches, as well as the revised Employee Polygraph Protection Act (EPPA) Poster.

July 18, 2016: ACA 1557: Provide interpreters, ensure accessibility
Under the Affordable Care Act, dentists participating as providers in the Denti-Cal, Medicare Advantage and CHIP (formerly known as Healthy Families) programs and those who have received Meaningful Use funding are required to comply with new federal anti-discrimination policies. They must provide interpreters or translators to patients with limited English proficiency, ensure accessible online appointment systems and billing, ensure employee health plans are in compliance with anti-discrimination laws, and comply with standards concerning dental facility alterations or new construction. 

July 1, 2016: Submit email address
Each individual licensed or permitted by the Dental Board of California or the Dental Hygiene Committee of California must submit an email address to the Dental Board. Send an email to dentalboard@dca.ca.gov, using the subject line "Electronic Mail Address Requirement" and include in the body of the email the individual's name, license type, license number and email address. The electronic mail address shall be considered confidential and not subject to public disclosure.

July 1, 2016: Register with CURES
All prescribers in California with U.S. Drug Enforcement Administration registrations are required to register to access California's prescription drug monitoring program, known as CURES 2.0.

July 1, 2016: Provide timely practice updates
Dentists contracted with dental plans must 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. Dental practices are required to provide timely practice updates, including practice address, license number, and other information.

June 1, 2016: Update hazard communication plans
Dental practices must have updated hazard communication plans and safety data sheets (SDS), place appropriate labels on secondary containers and train all staff on new chemical labeling and classification systems. CDA has developed a sample hazard communication plan and PowerPoint presentation for use in dental practices.

April 1, 2016: Develop new antidiscrimination policies
Amendments to California's Fair Employment and Housing Act regulations, which generally apply to employers of five or more employees, require employers to develop and distribute antidiscrimination, anti-harassment and complaint investigation policies. CDA has developed sample policy language and a sample employee manual template for dental practices.

April 1, 2016: Replace pregnancy leave posters
Dental practices must post Your Rights and Obligations as a Pregnant Employee (DFEH-100-20), which replaces "Notice A," addressing Pregnancy Disability Leave, as well as the California Family Rights Act.

Employers with 50 or more employees must post Family Care and Medical Leave (CFRA Leave) and Pregnancy Disability Leave (DFEH-100-21), replacing "Notice B."

Jan. 1, 2016: Display whistleblower, injury posters
Dental practices must post California's Whistleblower Protection notice, printed no smaller than 8.5 inches by 14 inches, as well as Notice to Employees – Injuries Caused by Work, in both English and Spanish if dentists have Spanish-speaking employees.

July 1, 2015: Provide three days of sick leave
All employers in California are required to provide their employees a minimum of three paid sick days per year. Calculated at one hour for every 30 hours worked, sick pay can be accrued over time or given as a lump sum. CDA offers numerous resources on navigating sick law, including a breakdown of sick leave ordinances by city and county.

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Regulations require employers provide specific training to employees and that employers document that training. See Required Employee Training for a list of training requirements.