Announcements

  • Practices may be required to change restroom signage

    Effective March 1, 2017, all single-occupancy restrooms in any business establishment, place of public accommodation or government agency must be identified as "all gender" and be universally accessible. The Equal Restroom Access Act, signed into law by Gov. Jerry Brown last September, applies to 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.

    A variety of all-gender signage is available for purchase but not all it complies with California law. The state of California requires the all-gender sign to have a geometric symbol that is an equilateral triangle superimposed onto a circle and the sign must be placed on the door. The symbol is not required to include pictograms, text or braille.

    The law authorizes inspectors or other building or local officials responsible for code enforcement to inspect for compliance.

    Find more information in the Jan. 19 issue of the Department of the State Architect Bulletin and on the California Building Standards Commission website..

  • EPA Reinstates Final Rule On Amalgam Separators.

    The ADA News (6/12, Garvin) reports that the Environmental Protection Agency issued a final rule on June 9 requiring most dental offices nationwide to install amalgam separators. The final rule, which closely follows the ADA’s best management practices, will be effective July 14, 2017, and the date for compliance is July 14, 2020. The EPA had issued the final rule in December 2016, but the agency withdrew the rule following the White House’s Jan. 20 memorandum ordering federal agencies to freeze all new or pending regulations. The ADA commended the agency for what it considers “a fair and reasonable approach to the management of dental amalgam waste.” In a statement, ADA President Gary L. Roberts said, “The ADA shares the EPA’s goal of ensuring that dental amalgam waste is captured so that it may be recycled.”

    The ADA provides more information at ADA.org/RecycleAmalgam. An unofficial version of the final rule is available online.

  • Proposition 65 resource updated for compliance

    Well ahead of the compliance deadline, CDA has updated its Proposition 65 resources to include the dental-specific notice that many dental practices (as well as dental schools and laboratories) will need to post at the entrance of the dental office by Aug. 30, 2018, unless the practice chooses instead to provide a warning with an informed consent form to be signed by the patient prior to exposure.

    The new notice, made available in 16 languages, replaces the three separate notices — for Bisphenol A (BPA), dental amalgam (and other restorative materials) and nitrous oxide — that dental practices formerly posted to comply with Proposition 65, known as the Safe Drinking Water and Toxic Enforcement Act. Since 2003, CDA has provided 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 BPA when that chemical was added to the list in April 2015.

  • State Dental Associations Ask HHS To Eliminate Certain Regulations.

    The ADA News (5/18, Garvin) reports that in a May 4 letter to Health and Human Services Secretary Tom Price, MD, the dental associations from all 50 states and Washington, DC asked the agency to eliminate “the Medicare mandate enrollment requirement for providers who don’t perform Medicare-covered services,” and to enforce Section 1557 of the Affordable Care Act as written without the promulgation of regulations. “Our associations believe that [these regulations] unnecessarily contribute to the cost of providing care, making it more difficult for our members to deliver oral health care services at an affordable price,” they wrote. The letter concluded, “Addressing these issues will help free dentists from unnecessary administrative burdens and allow them to focus on getting care to patients who need it.”

    Follow all of the ADA advocacy efforts at ADA.org/Advocacy.

  • C.E. certificates available May 30, courses on demand

    More than 18,000 dentists, dental team members and dental students attended CDA Presents The Art and Science of Dentistry, which concluded Saturday, May 6, in Anaheim.

    Convention attendees chose from more than 175 lectures, courses and workshops led by speakers who presented on topics ranging from CAMBRA to digital imaging and from pain control to restorative dentistry. Attendees also had many course topics to choose from in the areas of health and wellness — ergonomics and nutrition, for example, as well as in the practice management category, including financial planning and practice transition.

    As attendees return to their practices at the start of a new week, they may have some questions about any next steps required to receive their C.E. certificates and more. They can find below some answers and information to help wrap up their Anaheim experience.

    Post-convention pricing for attendees
    Many exhibitors honor special pricing offered at CDA Presents for attendees who mention they were at the convention. For a list of companies that displayed on the exhibit hall floor, see the exhibitor index on pages 179-209 of the On-Site Program or visit cdapresents.com. From the webpage, clicking on an exhibitor name will display the company's contact information, products, services and, if offered, special pricing.

    C.E. certificates available by May 30
    Hosts will provide a three-digit code during every CDA Presents C.E. course. Attendees should hold on to these codes until they have their C.E. certificates in hand. Certificates will be available three weeks from the convention’s closing date. Licensed attendees will receive an email notification with a CDA login link from which they can obtain their C.E. certificates. Certificates can also be accessed at cdapresents.com. Attendees who are nonlicensed or who prefer to have their certificates mailed may contact CDA at 800.232.7645 on or after May 30.

    Viewing select C.E. courses on demand
    Those who missed a continuing education opportunity at CDA Presents can purchase select C.E. courses and view them from the comfort of home or office. A complete list of on-demand courses is available at prolibraries.com/cda and is searchable by session or speaker. Audio recordings of select courses are also available. Additional information can be found at cdapresents.com/options.

    The fun and memories continue
    Hundreds of convention-related photos and updates were shared on Facebook, Instagram and Twitter over the course of the convention. Attendees who did not take part in the CDA Presents Social Hub — an interactive website featuring all of the social activity happening at the convention — can still view and share these memories at cdapresents.com/SocialHub.

    CDA Presents The Art and Science of Dentistry is one of the most anticipated dental conventions in the U.S. Aside from being the premiere destination in the state for dentists to earn continuing education credits, the convention is the place to discover the latest in dental technology. In Anaheim, attendees had 130,000 square feet of exhibit hall space to roam.

    Registration opens in late May for the CDA Presents fall convention. CDA looks forward to seeing new and regular attendees Aug. 24-26 in San Francisco. Watch for more information in the June issue of the CDA Update and on cda.org.

  • Practices required to post updated Wage Order 4

    As a best practice, all California practice owners or employers should know the applicable wage order for their business and employees along with the regulations contained in it.

    California’s Department of Industrial Relations regulates wages and hours of nonexempt employees. The wage orders, currently 17 in all, define the minimum wages, hours and working conditions of employees in specific industries. California employers must comply with one or more of the 17 wage orders, plus a minimum wage order as well as applicable statutes depending on the type of work performed.

    Dental practices typically fall under Wage Order 4 — specifically, Order No. 4-2001u, Regulating Wages, Hours and Working Conditions in the Professional, Technical, Clerical, Mechanical and Similar Occupations. The California Department of Industrial Relations 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) and also updated meal and lodging credit amounts. The correct industry wage order has a revision date of “12/2016,” which is found on the bottom of the cover page for each wage order. The wage orders are dated 12/2016; however, they were released by the DIR in May 2017.

    Each California Wage Order covers regulations on topics such as:

    Administrative, executive and professional exemptions.
    Overtime wages.
    Alternative workweeks.
    Minimum wages.
    Reporting time pay.
    Records retention.
    Cash shortage and breakage.
    Uniforms and equipment.
    Meals and lodging.
    Meal periods.
    Rest periods.
    Required posting of the order.


    Most wage orders contain similar provisions as stated; however, each can contain more obscure provisions. For example: “suitable seats when the nature of the work reasonably permits the use of seats.” Or for dental practices that are considering adopting an alternative workweek schedule, the details of what is allowed and required in order to adopt this type of schedule is spelled out in detail in Section 3(B).

    Although CDA recently printed and is continuing to distribute the most recent version of the Required Poster Set, it is difficult to know when state or federal postings will be updated. CDA Practice Support updates its resource “Required Postings in a Dental Office”   and encourages practice owners or employers to check the resource regularly to stay in compliance as new postings are updated and issued.

    As with the CDA Required Poster Set, employers should print a copy of the new wage order and post it in an area frequented by employees where it may be easily read during the workday. Where the location of work or other conditions make this impractical, every employer must keep a copy of this order and make it available to every employee upon request. The industry wage orders are formatted to print on 8 ½-inch by 11-inch paper.    

    Find "Required Posting in a Dental Office" and other Practice Support resources at cda.org/practicesupport.

    If you haven’t ordered your 2017-18 poster set yet, you can do so today at cda.org/posterset.

  • Resources Are Available To Help Dentists Avoid Ransomware Attacks.

    In the wake of the WannaCry ransomware attack, the ADA News (5/15) reports that the ADA Center for Professional Success has resources to help dentists fend off malware cyberattacks. Although most dentists are unlikely to be affected by this attack, according to Christopher Maag, director of the ADA Department of Technology Architecture and Infrastructure, dentists should be aware of the threat and know that the Center for Professional Success can help. Articles on the CPS site list several tips to help protect dental offices from ransomware. In addition, Mr. Maag advised replacing unsupported operating systems with a newer version and keeping computers up to date in regards to security patches and antivirus programs.

    Visit Success. ADA.org to access an article titled, “Protect Your Practice from Ransomware.”

  • Watch for Delta Dental proposed settlement notice

    Updated May 2, 2017

    Dentists who are part of a class action lawsuit against Delta Dental of California should expect to receive notices of the proposed settlement in the mail soon. Preliminary approval of the proposed settlement by a San Francisco Superior Court judge triggers a settlement administrator to issue formal notices to dentists who are part of the class.

    The proposed settlement is the result of legal action CDA filed against Delta Dental regarding Participating Dentist Agreements with providers in the Delta Dental Premier® network. CDA took a stand on behalf of members to protect their rights to fair dealings after learning of Delta’s plans to reduce Premier Provider rates by 8 to 12 percent. The legal action successfully blocked Delta’s attempt to reduce reimbursement rates for 3 ½ years, which saved dentists nearly a half-billion dollars in fee reimbursements.

    The settlement administrator has until May 12 to mail the formal notices to dentists and set up a website, deltadentalofcaliforniasettlement.com, and phone number for additional information. Dentists who choose not to participate in the class have a June 26 deadline to opt out. Dentists should read the notice carefully, including terms of the settlement and a revised PDA for Premier Providers.

    A final approval hearing on the proposed settlement is scheduled for Aug. 31 in San Francisco Superior Court. It is expected that all claims from the settlement amount will be completed within six months after the settlement becomes final. Any payments that remain unclaimed after 90 days will be paid to the CDA Foundation’s Student Loan Repayment Grant program.

    CDA is committed to supporting members in many ways, including the pursuit of this litigation on behalf of dentists. CDA also offers sophisticated practice management and dental benefits guidance through CDA Practice Support at cda.org/practicesupport, which offers important tools to assist with managing dental practices and evaluating accepted plans.

    CDA will continue to keep members informed about the proposed settlement process through the CDA Update, e-newsletter and cda.org/delta.

  • CDA updates guide to the California Dental Practice Act

    “Your Guide to California Dental Practice Act Compliance” was updated in January 2017 to reflect new laws concerning adverse event reporting, scope of practice, required language in the anesthesia informed consent form, online advertising through Groupon, notice of licensure, consulting the Controlled Substance Utilization Review and Evaluation System (CURES), prescriber dispensing of controlled substances and several other areas of practice.

    CDA last updated this guide in 2015 and offers it only to members and allied dental health professionals to assist them in complying with the California Dental Practice Act.

    The guide summarizes portions of the Dental Practice Act and organizes information in alphabetical order by subject. Some of the changes included in this latest edition are outlined here

  • New poster sets to stay ahead of labor law requirements

    Many dentists, in their roles as small business owners and employers, manage risks in areas beyond clinical care. A telling example is the requirement for all employers to post workplace labor law notices, since failure to comply in this area alone can result in substantial fines. 

    To assist members in the business ownership side of practice, CDA prints a full set of required posters every two years. The 2017-18 set is now available for distribution.

    The popular orange and grey poster set CDA provides is unique in that it has been developed not just for employers but specifically for dental practices. Within the enclosed notices, practice owners can find many answers to questions about employment in a dental practice, including:

    Questions about eligibility and use of California Paid Sick Leave;
    Employer and employee obligations related to managing meal and rest break laws;
    Employee and employer obligations related to Pregnancy Disability Leave;
    Information related to wages, hours and working conditions;
    Notice to Employees, Standards for Protection Against Radiation;
    Dental Board of California’s Infection Control Regulations;
    Scope of practice for dental hygienists; and
    Permitted duties for dental assistants.
    Employers are required to post information where it may be easily read and referenced in an area frequented by employees during the workday.

    CDA Practice Support supplements the poster set with a separate resource, “Required Postings in a Dental Office,” which lists current required postings and is updated throughout the year. CDA members can download new posters from the links provided, then print and place them over previous notices. This member resource can be found on the CDA Practice Support webpage and under “Regulations” on the “Advocacy” page of the CDA website.

    With rapidly changing employment laws, required postings can change periodically from the time of printing by CDA. Also, depending on the practice location, employers may be required to display additional posters, such as local minimum wage and paid sick leave laws notices, with eligibility rules and posting requirements varying from city to city. It is the responsibility of the practice owner or employer to regularly check federal, state and local city websites for updates and obligations.

    Maintaining compliance

    Once the CDA posters are received, simply posting them isn’t sufficient. For an employer to be in compliance, the following steps must be taken:

    Complete the contact fields on the Emergency poster.
    Complete the contact fields on the Access to Medical and Exposure Records poster.
    Complete the schedule information on the Pay Day Notice.
    Add the location of the medical provider network (MPN) notice, as applicable.
    Employers who use an MPN for workers’ compensation claims must obtain a notice from their carrier and post it in their practice.
    Complete contact information at the end of the Family Care and Medical Leave (CFRA Leave) and Pregnancy Disability Leave notice.
    Add the specific location of the practice's Protection Against Radiation poster.
    As a copy of state Radiation Control Regulations must be posted or made available to employees, employers who have not already posted these regulations may download “Radiation Safety In Dental Practice” on the CDA Practice Support page.

    Ordering poster sets

    Unlike prior years, posters are distributed upon request. It’s a quick and easy process to request one no-cost CDA poster set for a practice you own. Simply visit cda.org/posterset and sign in using your current login and password. Then, answer a few questions about your practice to confirm your order. Additional sets can be purchased for $15 from the CDA Practice Support online store. Once you’ve received your new posters, be sure to discard outdated posters as you replace them with the current set.

  • April Is Oral Cancer Awareness Month

    April Is Oral Cancer Awareness Month


    Oral cavity and oropharynx cancers account for 2.9 percent of all cancers diagnosed in the United States and 1.6 percent of cancer deaths. The American Dental Association recognizes that early oral cancer diagnoses have the potential to significantly impact treatment decisions and outcomes. The ADA also supports routine visual and tactile examinations, particularly for patients who are at risk, including those who use tobacco or who are heavy consumers of alcohol.
     
    Take time this month to review statistics, find a protocol for oral cancer examinations and educate your patients about their risk factors and signs and symptoms to watch for.
     
    Professional resources can be found on ADA.org. Patient resources on oral cancer, risk factors and the association with HPV can be found on MouthHealthy.org.

  • Become a Volunteer Leader

    Serving on a CDA council, committee or board is one of the many ways you can give back to your association and profession. CDA’s success depends on conscientious and dedicated volunteer leaders who share its vision and mission. Volunteering also provides benefits to participants, such as :



    • Enhanced leadership skills

    • Increased knowledge of the dental profession and related issues

    • Professional relationships with some of the best and brightest in dentistry.


    We are now accepting applications for CDA’s 2018 council, committee and board positions. Apply here! (login required)

  • ADA Applauds EPA’s Decision To Deny Petition To Ban Community Water Fluoridation.

    The ADA News (2/27, Manchir) reports the Environmental Protection Agency (EPA) has denied a petition from activist groups that sought to ban community water fluoridation. In a 50-page response to the petition, the EPA said the health benefits of fluoride include “having fewer cavities, less severe cavities, less need for fillings and removing teeth and less pain and suffering due to tooth decay.” In addition, the EPA said that the petitioners had “not set forth a scientifically defensible basis to conclude that any persons have suffered neurotoxic harm” due to community water fluoridation.

            The ADA released a statement Feb. 27 applauding the EPA’s decision, calling it “scientifically sound.” ADA President Gary Roberts said in the statement, “Public health policy recommending community water fluoridation results from years of scientifically rigorous analysis of the amount of fluoride people receive from all sources.”

            The ADA has long supported community water fluoridation as a safe and effective way to combat dental decay.

  • Updated anesthesia consent form required

    Under AB 2235, the pediatric anesthesia bill signed into law by Gov. Jerry Brown last September, dentists are required to obtain written informed consent from the parent or legal guardian of a minor patient prior to administration of general anesthesia or conscious sedation.

    As part of this requirement, the written informed consent form must contain new, specific language 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.”

    As covered in the September CDA Update, AB 2235 was introduced in response to a tragic incident involving the use of general anesthesia for a pediatric dental patient. Following in-depth discussions with the author, the patient's family and other stakeholders, many amendments were made to the original bill language, with CDA supporting the bill ultimately signed by Gov. Brown.

    In addition to the new specificity required in the written informed consent for minor patients, the law required additional data collection around anesthesia-related adverse events and the dental board’s review of current state policies on the use of anesthesia for minors, with recommendations due to the Legislature by Jan. 1, 2017. The Legislature is reviewing these recommendations and CDA expects to see additional legislation this year that will affect the administration of sedation and anesthesia for pediatric patients.

    CDA offers updated informed consent form

    CDA has updated its informed consent form to include the new required verbiage. The form is available in nine languages.

    CDA members can access “Guidelines for Informed Consent” at cda.org/resources. TDIC policyholders may also access the form at tdicinsurance.com.

  • CURES 1.0 not available after March 5

    CURES 1.0 will be discontinued on Sunday, March 5, 2017. The departments of Consumer Affairs and Justice have announced that beginning March 6 prescribing health care practitioners will only be able to access CURES 2.0.

    California’s Controlled Substance Utilization Review and Evaluation System, or CURES, is the state’s prescription drug monitoring program. It aids prescribers and dispensers in identifying the fraudulent or drug-seeking activity of patients. Dentists are strongly encouraged to consult CURES when considering prescribing a controlled substance for a new patient or a patient suspected of drug dependency. Also, under a new law, prescribers will soon be required to check a patient’s prescription history prior to prescribing a Schedule II-IV substance in certain situations, with some exemptions.

    CURES 2.0 has been active since January 2016 and, according to the Department of Consumer Affairs, the upgraded system accounts for more than 90 percent of patient activity report requests, which leaves a small number of users who will be affected by the discontinuation of CURES 1.0. All California prescribers with U.S. Drug and Enforcement Administration registrations were required to register for CURES 2.0 by July 1, 2016.

    Updated browser required to access CURES 2.0

    CURES 1.0 allowed user access from all web browsers, regardless of a browser’s security features. However, protection of confidential and sensitive patient data is of the highest priority and “Decommissioning CURES 1.0 is a necessary step toward protecting this information,” the DCA said in a statement.

    To securely access CURES 2.0, dentists will need to update their web browsers to one of the following:
    ◾Apple Safari
    ◾Google Chrome
    ◾Microsoft Internet Explorer, version 11.0 or higher
    ◾Mozilla Firefox

    Users who have not updated their browsers by March 5 will no longer be redirected to CURES 1.0.

    Exemptions to mandatory prescription checking

    Under a bill signed into law by Gov. Jerry Brown in September 2016, prescribers will soon be required to check a patient’s prescription history prior to prescribing a Schedule II-IV substance for the first time and every four months thereafter, if the substance remains part of the patient’s treatment plan. Due to concerns with how this process could unnecessarily interfere with patient care, CDA successfully secured an exemption for providers in cases where they are prescribing a Schedule II-IV substance as a part of the treatment for a surgical procedure and the prescription is nonrefillable and for a duration of five or fewer days. The exemption maintains the intent of CURES to provide information that will help reduce prescription abuse while removing an unnecessary burden.

    This requirement has not yet taken effect and will not take effect until six months after the Department of Justice certifies that CURES is fully ready for statewide use and the DOJ is adequately staffed. CDA will keep members informed of the compliance date on cda.org and in the CDA Update.

    Visit the CURES website at oag.ca.gov/cures. For assistance, contact the DOJ’s CURES help desk at 916.227.3843. CDA members can also reference the CDA Practice Support reference “Controlled Substances Prescribing and Dispensing.”

  • Presidential order freezes amalgam separator rule

    The Environmental Protection Agency’s anticipated rule requiring that dental practices install amalgam separators and implement best practices to control the discharge of mercury and other metals entering the waste stream has been delayed following the Trump administration’s freeze on all proposed or pending federal regulations. The freeze is intended to allow the administration time for executive review of the regulations. Once the freeze is lifted, requirements of the new rule will take effect 30 days after publication in the Federal Register, which was previously scheduled for Jan. 24.

    Under the proposed EPA rule, as reported on cda.org and in the CDA Update, most dental practices must install amalgam separators that are compliant with either the American National Standards Institute (ANSI) American National Standard/American Dental Association Specification 108 for Amalgam Separators (2009) with Technical Addendum (2011) or the International Organization for Standardization (ISO) 11143 Standard (2008) or subsequent versions as long as that version requires amalgam separators to achieve at least a 95 percent removal efficiency.

    CDA recognizes that dental amalgam is a safe and cost-effective restorative material. As environmental stewards, dentists are encouraged to adhere to best practices for the recycling and disposal of amalgam to reduce dental office waste. The use of dental amalgam separators is recommended to assist in this effort.

    Additionally, in anticipation of this ruling, CDA has been working on behalf of its members to identify resources that make complying with the future mandate easier and more affordable.

    CDA has secured the PureLife ECO II amalgam separator as the newest CDA Endorsed Program. An exceptional dental supplier and longtime CDA partner, PureLife balances patient health, planet-friendly choices and exceptional savings for the best total value.

    CDA has negotiated with PureLife to offer this quality amalgam separator at a member-exclusive price. The ECO II is an ISO 11143-certified amalgam separator that retails for $499. CDA members will pay only $99 per unit with a discounted one-year replacement cartridge and disposal service agreement ($249).

    CDA Practice Support is developing a new Q&A resource to help dentists understand their obligations under the ruling and will make the resource available to dentists if and when the rule is published. CDA will keep members informed about developments on cda.org and in the CDA Update.

  • Update: Mycobacterium Infections Associated with a Local Dental Clinic

    To Orange County Medical Providers,

    Mycobacterium abscessus dental infections have been reported in patients who have undergone pulpotomy procedures at the 2156 East Lincoln Avenue office of Children's Dental Group in Anaheim.

    The facility’s internal water system appears to have been the source of mycobacteria based on the Orange County Health Care Agency’s facility assessment and laboratory testing. The facility discontinued performing pulpotomy procedures from September 6-November 7, 2016 in order to replace their water system and install appropriate infection control safeguards. On December 15, 2016, after the facility had restarted performing pulpotomies, OCHCA’s Public Health Laboratory identified Mycobacterium mucogenicum growing from multiple clinical water samples obtained as part of follow up testing at the facility. Though M. mucogenicum is not known to pose the same risk to dental patients as M. abscessus, the identification of any mycobacterium (even at low levels) was of sufficient concern that the County Health Officer issued a second order requiring closure of the clinic pending further investigation of the situation.

    Current Status of the Outbreak

    67 children have been reported to have slowly progressive oral cellulitis consistent with mycobacterial infection following dental pulpotomy procedures at this facility. Additional potential cases are undergoing clinical assessment. 21 of the 67 cases have been identified by culture to have mycobacterial infection; 20 cases had Mycobacterium abscessus identified and one developed infection with Mycobacterium chelonae. Symptoms have begun a median of 71 days (range 15-305 days) after pulpotomy and progressed despite treatment with commonly used antibiotics such as amoxicillin, Augmentin (amoxicillin/clavulanate), or clindamycin. Infections have been identified in children who have received pulpotomies performed from February 4 to August 20, 2016.

    Recommendations for Dental Care Follow Up

    Because the incubation period for these infections has been as long as 10 months, and initial symptoms can be mild, dentists caring for these patients should conduct follow up exams for an extended period of time.

    The Orange County Health Care Agency recommends that patients who have had a pulpotomy from the Children’s Dental Group from January 1, 2016-December 15, 2016 have periodic follow-up dental examinations for one year after their procedure. Exams should occur monthly for the first 6 months after the procedure, then every two months for the second 6 months after pulpotomy.
    Page 2 of 2

    Additional Notes

    It is uncertain what additional risk, if any, exists for the 17 children who received pulpotomies after the facility reopened and M. mucogenicum was subsequently identified in the facility’s water system. None have developed evidence of mycobacterial infection to this point. OCHCA is working to arrange dental follow up for these children to assure any necessary treatment is provided expeditiously.

    Additional clinical characteristics in cases have frequently included some combination of the following:

     Dental abscess  Cervical or submandibular lymphadenitis  Granulomatous inflammation of affected tissue on pathology  Cultures positive for acid fast bacilli from biopsy specimens of infected sites  Multiple small pulmonary nodules identified on chest CT scan.

    The facility has been working cooperatively with the Orange County Health Care Agency in the ongoing investigation. No suspect infections have been identified in other area dental practices, including other Children's Dental Group locations.

    Information or questions about possible cases or the investigation should be referred to the Orange County Health Care Agency Epidemiology Program at 714-834-8180.

  • Google update pulls reviews from across web

    Historically, dental practices have relied heavily on word of mouth. Patients share the great experience they had at a dental practice and encourage their friends and family to choose the same dentist. What dentists often don’t think about is the patient who might have had a negative experience.

    The consequences of a negative consumer experience continue to challenge practice owners. Now the reach of consumers’ opinions can extend past family and friends to the web, where review sites allow a reach that is likely immeasurable.

    Consequently, dentists should take note of a Google update launched in mid-September that pulls business reviews from other websites and displays those reviews in the “knowledge panel” — a box of information that appears on the right side of Google search results. Previously, only Google reviews appeared in the knowledge panel, but now reviews from other websites such as Facebook and Healthgrades are also displayed in the form of “votes” with links to those reviews.

    CDA marketing expert Courtney Isett says consumers are increasingly turning to online review sites to make business decisions. In fact, some studies show that more than 85 percent of consumers report they trust online reviews as much as personal recommendations.

    “Online reviews are the new word of mouth,” Isett said. She also noted that while the Google update provides consumers access to more reviews, it also opens the door for dentists to further refine and manage their online reputations.

    “With Google’s integration of other online reviews dental practices have a great opportunity to optimize all of their online profiles,” Isett said. “This way if someone clicks on your Facebook vote, your future patient will have all the information needed to contact your practice.”

    Visit CDA Practice Support for marketing resources.

  • OCDS Members Group Facebook Page

    OCDS Dental Professional Members Only. We are the local Orange County component of the California Dental Association.

  • White House Issues Memorandum Freezing All New And Pending Regulations.

    DENTISTRY IN THE NEWS White House Issues Memorandum Freezing All New And Pending Regulations. The ADA News (1/23, Garvin) reports that the White House issued a memorandum on Jan. 20 to federal agencies, ordering them to freeze all new and pending regulations in order to allow the Trump administration opportunity to review. According to the article, “The mandate, which is similar to what the Obama administration did in 2009 and the Bush administration in 2001, applies to any regulation that has not been published in the Federal Register or yet taken effect.” Among the regulations affected is “the Environmental Protection Agency’s final rule requiring dental offices nationwide to install amalgam separators by 2019.” The EPA will need to resubmit the rule. The Confidentiality of Substance Use Disorder Patient Records final rule, which was expected to take effect on Feb. 17, is also affected and will now be postponed. The freeze does not affect the Food and Drug Administration’s final rule banning most powdered gloves, which went into effect Jan. 18.

  • CDA Urges Lawmakers to Use Prop. 56 Funding as Voters Intended

    The governor released a disappointing 2017-18 budget proposal last week, which proposes using Proposition 56’s Medi-Cal funding to cover cost increases in the program rather than boosting provider reimbursement rates. This disregards language in the measure stating that the funds were to provide improved payments for services and to supplement, not offset, state general fund obligations to Medi-Cal. We and CMA put out statements expressing our disappointment (CDA Press Release be read by clicking on the link below). We’re coordinating with the Proposition 56 coalition on strategy and we’ll be working closely with legislators to prevent the proposed diversion of funds. The governor’s annual January budget release is a starting point for negotiations with the Legislature and they have until June 15 to reach an agreement. In good news, the $30 million annually dedicated by Proposition 56 to the state oral health program overseen by the dental director was included. The governor is citing slowed growth in state revenues and a projected deficit by next summer for the need to slow down overall spending and offset the state general fund’s obligations to Medi-Cal. The proposal does not incorporate any possible changes in federal funding that may occur with a repeal of the Affordable Care Act, but uncertainty around what a replacement will look like is very much lingering over budget considerations. The latest statements from the president-elect and Republican congressional leadership are that they will pass a replacement at the same time as the repeal, but the timing is unclear, as a replacement is yet to be released.

  • Volunteers needed for CDA Cares San Mateo

    A CDA Cares volunteer dental clinic is scheduled April 22-23, 2017, at the San Mateo Event Center. To help provide oral health care services at no charge to the large number of expected patients, the CDA Foundation needs volunteer dentists, including oral surgeons, as well as dental hygienists, assistants, dental lab technicians, physicians, nurses and pharmacists.

    Additionally, community volunteers are needed to help escort patients, translate/interpret, dispense medication, set up and tear down the clinic, register patients and volunteers, conduct exit interviews, enter data and provide oral health education.

    The main goal of the clinic is to relieve pain and eliminate infection by providing cleanings, fillings, extractions and oral health education to approximately 2,000 people during the two-day event.

    Volunteers can register for one six-hour shift or multiple shifts per day during the following times:
    • Friday, April 21: Clinic setup from 9 a.m. to 6 p.m. (no patients)
    • Saturday, April 22: Dental clinic from 5 a.m. to 7 p.m.
    • Sunday, April 23: Dental clinic from 5 a.m. to 10 p.m. (including clinic breakdown)

  • Dentist Ranked #1 Job In America By U.S. News & World Report.

    U.S. News & World Report (1/11, Snider) has released its list of the 100 Best Jobs of 2017, highlighting the professions that offer “great growth potential, enviable work-life balance, high wages and low unemployment.” Dentist tops this year’s list, and orthodontist and oral and maxillofacial surgeon are also among the top 10 jobs for 2017. U.S. News & World Report provided a press release with more information on the list.
    MarketWatch (1/11) reports that to determine the rankings, U.S. News & World Report “looked at hiring demand, salary, employment rate, 10-year growth, future prospects, stress levels and work-life balance.” Dentist took the top spot, scoring “points for high pay (median salary $152,700), low unemployment (0.1%) and solid work-life balance.”
    In a second piece, U.S. News & World Report (1/11, Hill) discusses the dentistry profession and states that although sometimes people may be afraid to go to the dentist, “patients have to know that dentists are doing what’s best for them,” according to American Dental Association spokesperson Dr. Ada Cooper.
    CBS News (1/11) reported on the rankings in a broadcast on its website, stating “the best job of 2017 is a dentist.”
    The New York Daily News (1/11, Jagannathan) notes that more than half of the top 100 jobs are in the healthcare field.

  • FDA bans use of powdered gloves in health care

    Dentists, physicians and other health care professionals will no longer be allowed to use powdered gloves when treating patients, per a rule finalized Dec. 16 by the U.S. Food and Drug Administration.

    First proposed in March 2016, the rule, which takes effect Jan. 18, prohibits the manufacturing, sale, distribution and use of (1) powdered surgeon’s gloves, (2) powdered patient examination gloves and (3) absorbable powder used to lubricate surgeon’s gloves because “they pose an unreasonable and substantial risk of illness or injury to health care providers, patients and other individuals who are exposed to them.”

    Powder is added to gloves to make it easier to put them on and remove them, but this powder is associated with an extensive list of potentially serious events, including airway inflammation, wound inflammation and post-surgical adhesions, according to the FDA. The agency reasserted that nonpowdered alternatives to powdered gloves provide similar protection, dexterity and performance, but “without any of the risks associated with powdered gloves.”

  • Completed Assurance of Compliance form required

    Dental practices that are required to comply with Section 1557 of the Affordable Care Act must complete and submit to the U.S. Department of Health and Human Services the Assurance of Compliance form. HHS 690 is a statement that the recipient of federal financial assistance is in compliance not only with the ACA’s Section 1557, but with: Title VI of the Civil Rights Act of 1964; Section 504 of the Rehabilitation Act of 1973; Title IX of the Education Amendments of 1972; and The Age Discrimination Act of 1975.

    The applicant “provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts, property, discounts or other federal financial assistance from the U.S. Department of Health and Human Services.”

    For more details about Section 1557, see the articles in the September and December 2016 issues of the CDA Update.

    HHS 690 can be downloaded, then completed and mailed to the address listed on the form. Alternatively, the form can be completed and submitted online.

  • New, easier to use Form I-9 available now

    Practice owners who are hiring or planning to hire new employees soon should use the newest version of the Employment Eligibility Verification, Form I-9. U.S. Citizenship and Immigration Services announced that the latest revisions of the form have been approved by the Office of Management and Budget.

    Employers or authorized representatives of employers may continue using the current form with the noted expiration date of March 31, 2016, until Jan. 21, 2017. After that date, all previous versions of the Form I-9 will be invalid.

    “The new form clarifies several points of confusion for employees and employers and is designed to be easier to use,” CDA Practice Analyst Michelle Corbo says. For example, the form will now include embedded instructions for completing fields and certain fields will include validations to ensure information is correct. The form will allow space for the correct number of Social Security number digits or an expiration date to be entered.

    In addition, to avoid possible discrimination, the new version of the form will require employees to provide only other last names used, as opposed to all other names used, to protect the privacy of transgender and other individuals who have changed their first names.

    Laws and best practices on form retention, storage

    As a best practice, employers should complete all required new employee paperwork, including the Form I-9, by the end of the first workday. Employers completing the I-9 online will still need to print the form, have the employee sign it and store the document in a safe place.

    The law states that “employers must have a completed Form I-9 on file for each person on their payroll who is required to complete the form.” It is important that practice owners correctly identify employees and independent contractors. Independent contractors are not considered employees of the practice and, thus, are not required to fill out the form.

    Forms must be retained for either three years after the date of hire or for one year after employment is terminated, whichever is later. Ideally, forms can be kept in the confidential personnel files of individual employees but, as a best practice, it is recommended they be housed and stored securely (because of the sensitive confidential information) in a separate binder. This binder facilitates the ease of producing the forms on file for an inspection request, should one occur, or for periodically auditing and shredding old forms. During an inspection, all forms retained for current and past employees can be included in an audit.

    Access the new Form I-9 at the U.S. Citizenship and Immigration Services’ website no later than Nov. 22. Dentists can also find a link to the form in the New Employee Checklist, a CDA Practice Support resource available at cda.org/resources.


















    Practice owners who are hiring or planning to hire new employees soon should use the newest version of the Employment Eligibility Verification, Form I-9. U.S. Citizenship and Immigration Services announced that the latest revisions of the form have been approved by the Office of Management and Budget.

    Employers or authorized representatives of employers may continue using the current form with the noted expiration date of March 31, 2016, until Jan. 21, 2017. After that date, all previous versions of the Form I-9 will be invalid.

    “The new form clarifies several points of confusion for employees and employers and is designed to be easier to use,” CDA Practice Analyst Michelle Corbo says. For example, the form will now include embedded instructions for completing fields and certain fields will include validations to ensure information is correct. The form will allow space for the correct number of Social Security number digits or an expiration date to be entered.

    In addition, to avoid possible discrimination, the new version of the form will require employees to provide only other last names used, as opposed to all other names used, to protect the privacy of transgender and other individuals who have changed their first names.

    Laws and best practices on form retention, storage

    As a best practice, employers should complete all required new employee paperwork, including the Form I-9, by the end of the first workday. Employers completing the I-9 online will still need to print the form, have the employee sign it and store the document in a safe place.

    The law states that “employers must have a completed Form I-9 on file for each person on their payroll who is required to complete the form.” It is important that practice owners correctly identify employees and independent contractors. Independent contractors are not considered employees of the practice and, thus, are not required to fill out the form.

    Forms must be retained for either three years after the date of hire or for one year after employment is terminated, whichever is later. Ideally, forms can be kept in the confidential personnel files of individual employees but, as a best practice, it is recommended they be housed and stored securely (because of the sensitive confidential information) in a separate binder. This binder facilitates the ease of producing the forms on file for an inspection request, should one occur, or for periodically auditing and shredding old forms. During an inspection, all forms retained for current and past employees can be included in an audit.

    Access the new Form I-9 at the U.S. Citizenship and Immigration Services’ website no later than Nov. 22. Dentists can also find a link to the form in the New Employee Checklist, a CDA Practice Support resource available at cda.org/resources.

  • Copies of Form W-2 must be filed by Jan. 31

    The Internal Revenue Service moved the annual deadline for filing copies of employees’ Form W-2, W-3 and certain forms reporting nonemployee payments to independent contractors (such as Form 1099-MISC) with the Social Security Administration. The new deadline of Jan. 31 was established by the Protecting Americans from Tax Hikes (PATH) Act to make it easier for the IRS to legitimize tax returns and spot errors based on the earned income tax credit and the refundable portion of the child tax credit in order to reduce fraud and improper payments.

    Historically, employers filing paper forms had until the end of February and employers filing electronically had until the end of March. The IRS is working with payroll providers and others to inform employers of the new deadline.

    Employers are still expected to meet the Jan. 31 deadline when providing copies of the forms to employees.

    The new law may in some cases allow the IRS to send taxpayer refunds faster; however, some returns needing further review could face delays. The IRS states that taxpayers claiming the Earned Income Tax Credit or the Additional Child Tax Credit will not see refunds until Feb. 15, at the earliest.

    Change to extension requests

    The responsibility for filing forms and extensions and informing payroll administrator falls upon employers.

    Employers should verify filing status, correct mailing addresses for employees and confirm that W-9 information for 1099-MISC contractors is current and accurate prior to the end of the year.

    Under a change to extension requests, only one 30-day extension to file the Form W-2 is available and it is not automatic. Form 8809, Application for Extension of Time to File Information Returns must be completed prior to the Jan. 31 deadline.

    Due to the shortened deadline between the end of the year and the new filing date, employers or payroll administrators should to have these forms ready to go by Jan. 1, 2017.

    Find more information at irs.gov. Access Form 8809 at irs.gov.

  • Mark your calendars for CDA Cares San Mateo

    A CDA Cares volunteer dental clinic is scheduled April 22-23, 2017, at the San Mateo Event Center. To help provide oral health care services at no charge to the large number of expected patients, the CDA Foundation needs volunteer dentists, including oral surgeons, as well as dental hygienists, assistants, dental lab technicians, physicians, nurses and pharmacists.

    Additionally, community volunteers are needed to help escort patients, translate/interpret, dispense medication, set up and tear down the clinic, register patients and volunteers, conduct exit interviews, enter data and provide oral health education.

    The main goal of the clinic is to relieve pain and eliminate infection by providing cleanings, fillings, extractions and oral health education to approximately 2,000 people during the two-day event.

    Volunteer registration will open in January. For more information, visit cdafoundation.org/sanmateo.

  • New overtime rule blocked by federal judge

    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.

  • New state minimum wage to take effect Jan. 1

    Many California employees will begin earning a new minimum wage on Jan. 1, 2017, per legislation signed by Gov. Jerry Brown in April.

    Under the new state law, dental practice owners with 26 or more employees must begin paying a minimum wage of $10.50 (an increase of 50 cents over the current state minimum wage) on Jan. 1. Practice owners with 25 or fewer employees have an additional year to comply with the law; they are required to begin paying the new wage on Jan. 1, 2018. The minimum wage will then increase annually each January — to $11 an hour in 2018 and then by $1 each successive year until the minimum wage reaches $15, in 2022 (for employers with 26 or more employees).

    Again, employers with 25 or fewer employees will have an extra year to comply with each annual wage increase. Once the minimum wage reaches $15, it is set to increase annually with inflation.

    Scheduled minimum wage increases beginning January 2017 or 2018



    Wage


    26 or more employees


    25 or fewer employees


    $10.50/hour

    Jan. 1, 2017

    Jan. 1, 2018


    $11/hour

    Jan. 1, 2018

    Jan. 1, 2019


    $12/hour

    Jan. 1, 2019

    Jan. 1, 2020


    $13/hour

    Jan. 1, 2020

    Jan. 1, 2021


    $14/hour

    Jan. 1, 2021

    Jan. 1, 2022


    $15/hour

    Jan. 1, 2022

    Jan. 1, 2023




    The law does allow the governor to suspend a scheduled wage increase in the event of an economic slowdown (negative job growth combined with negative retail sales for a specified time period) or if a budget deficit is forecasted for the current budget year up to two additional years. According to a state government fact sheet on the minimum wage increase, a deficit occurs “if the operating reserve is projected to be negative by more than 1 percent of annual revenues.” The governor may only suspend the increase due to a budget deficit twice.

    Required notices, local ordinances

    Employers are required to post a new official notice that communicates the new minimum wage. Dentists must post the notice in a visible location frequented by employees. The downloadable poster will be available on the website of the state Department of Industrial Relations.

    Additionally, more than 20 California cities, as well as one county, have minimum wages that are equal to, surpass or will surpass the state minimum wage in 2017. These include Berkeley; El Cerrito; Emeryville; Los Angeles (city); Los Angeles (county); Mountain View; Oakland; Pasadena; Palo Alto; Richmond; Sacramento; San Diego; San Francisco; San Jose; Santa Clara; Santa Monica; and Sunnyvale.

    Practice owners should check with their local jurisdictions or city websites to ensure they are in full compliance. Practice owners may also reference the CDA Practice Support resource, Minimum Wage and Paid Sick Leave Ordinances by City, available at cda.org/practicesupport. The resource lists individual city and county minimum wages, with links to notices, wage orders and FAQ.

  • Overtime rule will not take effect Dec. 1

    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.

  • Tobacco tax will save lives, improve oral health

    CDA is excited to report that Proposition 56, co-sponsored by CDA to raise the state’s tobacco tax by $2, passed overwhelmingly in yesterday’s election with 62 percent of the vote.
    Winning a ballot measure campaign in California is a massive undertaking, especially with an opposition as powerful and well-funded as the tobacco industry. We are grateful for the member support that made participation in this campaign possible, and to those who went the extra step to help us collect qualifying signatures, distribute campaign materials and spread the Yes on 56 message.
    CDA, along with our coalition partners, has taken a significant step to address a critical public health issue and improve oral health in California. Proposition 56 will save thousands of lives, save the health care system billions of dollars, and provide substantial new funding for Medi-Cal provider reimbursements so more patients can get care. Also, the state oral health program overseen by California’s dental director will now receive $30 million per year, a tenfold increase in state funding for a program that has not previously had a dedicated revenue source.
    The success of Proposition 56 is another example of what we are capable of accomplishing through our collective efforts and working with our partners in health care.
    Further updates on Proposition 56 and our progress on next steps will be provided in the CDA Update, e-newsletter and cda.org.

  • Delta's Medicare requirement won't apply in California

    Recent contractual amendments made by Delta Dental of Michigan, Ohio and Indiana effective Jan. 1, 2017, state that dentists who chose to opt out of Medicare Part D in these three states will no longer be eligible to remain Delta Dental network providers. This amendment is specific to Michigan, Ohio and Indiana and will only impact dentists in those three states, despite recent statements by a company advertising to help dentists with Medicare provider enrollment.

    Delta Dental of California verified that it is not adopting the same policy and is in the midst of building separate Medicare networks for its PPO and DeltaCare HMO products to ensure its Medicare enrollees receive coverage on Part D prescriptions and to reduce patient complaints.

    All dentists are encouraged to evaluate whether Medicare participation is right for them and their patients by taking appropriate action to enroll as a Medicare provider, enroll as an ordering/referring provider or opt out of Medicare participation by utilizing the resources provided by CDA and ADA. The Centers for Medicare & Medicaid Services, administrator of the Medicare program, has urged providers to submit one of the enrollment or the opt-out forms four or five months in advance of the Feb. 1, 2017, compliance deadline.

  • Civil rights rule compliance required by Oct. 16

    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.
    Meanwhile, the ADA has submitted a letter to the director of the OCR requesting an extension of the compliance deadline to help dentists who have "limited staffs and resources" comply with the final rule.
    "The ADA respectfully requests a delay in the enforcement date until there is sufficient time to allow for our members to meet the requirements," the letter states. The ADA has also asked that the "most burdensome regulations" apply only to dental practices with at least 25 staff. Further ADA efforts include mobilizing members to urge their congressional representatives to take action. Dentists who wish to take part in this grassroots effort can sign on at the ADA's legislation action center.
    CDA will inform its members of any granted deadline extensions or other developments on cda.org and in upcoming issues of the CDA Update.

  • Dental board email address requirement in effect

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

  • Prop. 56 campaign blasts Big Tobacco

    Reprinted with permission from California Dental Association

    In the final countdown to the November election, the Yes on 56 campaign to increase California’s tobacco tax is gathering major endorsements and strongly fighting back against Big Tobacco’s dishonest advertising.

    The California State PTA, the California Faculty Association, the California State Association of Counties and dozens of business organizations have joined the growing coalition supporting the measure. The campaign is also receiving overwhelming support from media outlets, including endorsements (as of early September) from the editorial boards of the San Francisco Chronicle, San Jose Mercury News, Monterey Herald and Santa Cruz Sentinel, which issued strong statements about the deceitful tactics employed by Big Tobacco to fight Proposition 56.

    The San Francisco Chronicle called out Big Tobacco for “trying, ever so ludicrously, to cast Prop. 56 as a ‘special interest tax grab’ by insurance companies,” and affirmed that, in fact, the measure “stipulates that 80 percent of the Medi-Cal funding must go to patient care.”

    Proposition 56 generates revenue for critical state health care programs such as Medi-Cal and Denti-Cal, which are significantly underfunded despite the fact that one-third of Californians now rely on these programs for health coverage.

    The Chronicle described other claims from the tobacco industry as “laughable” and “disingenuous.” State Superintendent of Public Instruction Tom Torlakson, another endorser, recently issued a public letter that blasts tobacco companies for their “false and misleading contention” that the proposition takes money from schools.

    “Make no mistake, Proposition 56 will not divert a dime away from schools,” Torlakson said. “Rather, it will raise revenues for school-based tobacco prevention and intervention programs. These claims are not only preposterous, they are insulting to those of us committed to the
    education and well-being of California’s children,” Torlakson added, while the California School Boards Association stated, “Prop. 56 protects school funding while helping to keep our kids from getting hooked on deadly, addictive tobacco.”

    The Sacramento Bee’s political fact-checker, PoliGRAPH, analyzed a recent radio ad by the “No” campaign and concluded, “The tobacco industry is omitting significant information.” Similarly, the fact-checking website PolitiFact, in “Big Tobacco blowing smoke in claim about California’s Prop. 56” observed that no money would be taken from schools under the proposition. The Yes on 56 campaign sent a cease-and-desist letter to broadcasters over the ad.

    The Legislative Analyst’s Office estimates that Proposition 56 would add approximately $20 million in new funding for comprehensive anti-tobacco instruction and cessation efforts in classrooms.

    Additionally, the No on 56 campaign (which is funded entirely by tobacco companies) has made duplicitous claims that the measure doesn’t help smokers enough. In fact, higher tobacco taxes have been proven to reduce tobacco use. Moreover, Proposition 56 will more than triple funding for the state tobacco control program. Also, improving access to dentists and other health care professionals is key to communicating the dangers of tobacco to patients. Dentists and other providers are often the first, or sometimes only, line of communication and counseling for many patients when it comes to tobacco use.

    Safeguards such as independent audits and strict caps on overhead spending and administrative costs are also built into the measure to ensure transparency and accountability.

    Vote-by-mail begins Oct. 10, grassroots efforts continue

    With little more than a month to go before election day, the campaign encourages Proposition 56 advocates to continue with their grassroots efforts. Dentists and dental students can contact their local component dental societies, CDA student representatives, specialty groups and ethnic societies for materials, including lab coat cards, buttons and stickers. Supporters can also download free materials, such as posters, from cda.org/advocacy/legislation/proposition-56. CDA asks that supporters share the materials with colleagues, patients and friends and explain how this measure will save lives and improve California’s health care system.

    If passed, Proposition 56 will raise the state’s tax on tobacco products (now among the lowest in the nation) by $2 — from 87 cents per pack of cigarettes to $2.87 per pack. An equivalent increase will apply to all products containing nicotine derived from tobacco (but not tobacco cessation devices), which would apply the tax to electronic cigarettes for the first time. E-cigarette use by teens is increasing rapidly and teens who smoke e-cigarettes are twice as likely to smoke traditional cigarettes.

    In addition to funding for health care programs, Proposition 56 will also generate revenue for cessation and research programs, and allocate $30 million for the state’s oral health program overseen by the new state dental director, an unprecedented dedicated funding source.

    Voting by mail begins Oct. 10. See the campaign timeline below for other critical dates.

     For more information about the tax initiative and the Yes on 56 campaign, visit yeson56.org.

    Campaign timeline:

    • Oct. 10: Vote-by-mail ballots begin.
    • Oct. 24: Voter registration deadline.
    • Nov. 1: Vote-by-mail request deadline.
    • Nov. 8: General election and postmark deadline for vote-by-mail ballot.

    Copyright © 2016 California Dental Association

  • Comply with Office of Civil Rights’ rule by Oct. 16

    Reprinted with permission from California Dental Association

    Dentists participating with Denti-Cal or Medicare (including Medicare Advantage plans) must comply with the Department of Health and Human Services’ Office for Civil Rights’ final rule implementing the prohibition of discrimination under Section 1557 of the Affordable Care Act.

    By Oct. 16, dentists will need to comply with the following:

     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.

    For assistance with meeting the compliance deadline, including the required notices, download the CDA resource “Nondiscrimination Requirements Under the Affordable Care Act (Section 1557)” at cda.org/practicesupport.

    • For more details about the new rule, see the related story in the September issue of the CDA Update.

    Copyright © 2016 California Dental Association

  • Section 1557 compliance resources online

    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. 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.
    The new CDA resource, "Nondiscrimination Requirements Under the Affordable Care Act (Section 1557)," provides a detailed background on the ACA provision and new OCR rule. It will also include a checklist, instructions and recommended practices for dental practices to follow to meet the compliance requirements under the July 18 deadline and the forthcoming Oct. 16 deadline (see the related story in the August issue of the CDA Update, page 10); sample grievance procedure and notice of nondiscrimination forms; questions and answers; and a list of additional resources.
    The zip file of resources will be available on the CDA practice support website in approximately two weeks (by Aug. 26).

  • Delta Dental dropped its first round of letters last week to participating providers

    Delta Dental dropped its first round of letters last week to participating providers as part of the provider directory verification process required by California Senate Bill 137 (SB 137). Hard copy letters were mailed to 8,600 dental practices in various parts of the state, ranging from Alameda to Riverside counties. We are awaiting details as to when the remaining two mailings will go out.

    Dentists who received a letter from Delta Dental as part of this first mailing are required to comply with SB 137 by verifying or updating their dental practice information by September 10th. Failure to respond could result in payment delays or, eventually, termination from the plan’s network. There are several resources regarding SB 137 on cda.org and members are welcome to call CDA with specific questions.

  • Employers required to e-file and e-pay with EDD under new law

    Beginning Jan. 1, 2017, employers with 10 or more employees will be required to register with the Employment Development Department's e-Services for Business and to 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.

  • Volunteer registration for CDA Cares is now open

    Join us in Stockton and help create thousands of stories of health and happiness for community members in need.
    CDA Cares Stockton
    Saturday, Oct. 15 and Sunday, Oct. 16, 2016
    San Joaquin County Fairgrounds
    1658 S. Airport Way
    Stockton, CA 95206
    Put your compassion into action. Volunteer with

  • Providing sign language in dental practices

    It is a question asked regularly of CDA Practice Support analysts — under what circumstances does a dental practice need to provide a sign language interpreter for a patient? The CDA Practice Support resource titled Americans with Disabilities Act and Disability Rights Laws offers valuable information about accommodations that dental practices are obligated to provide under the law.

    The Americans with Disabilities Act (AwDA) and related state and federal laws prohibit discrimination on the basis of disability in employment, government, public accommodations, education, commercial facilities, telecommunications and transportation. The law also helps guarantee access to places of public accommodation, including dental offices, for persons with disabilities.

    Compliance with these laws includes communication that is offered in forms that are readily understood by employees and patients. This may include the obligation to provide sign language interpreters at no cost to the patient.

    Practices are required to communicate with a deaf or hearing-impaired patient so that the patient is able to understand what is being said to him or her. The options for communicating to a hearing-impaired patient include using the following:
    ◾Printed or written instructions, questions, responses via paper and pen, computer or other device.
    ◾Lipreading.
    ◾Sign language.

    Practices should ask patients about their preferred method of communication. While not all hearing-impaired patients request a sign language interpreter for their appointments, be prepared to provide one if requested.

    CDA Practice Support offers a list of agencies that provide sign language interpreters or referrals to interpreters. Most require two weeks' notice prior to the appointment. Additionally, Denti-Cal will provide interpreters for its beneficiaries with advance notice.

    If a patient brings his or her own sign language interpreter for an office visit without prior consultation and bills the practice for the cost of the interpreter, the practice is not obligated to pay for it. The provider must be given an opportunity to consult with the patient and make an independent assessment of what type(s) of auxiliary aid, if any, is necessary to ensure effective communication. If a patient believes the provider's decision will not lead to effective communication, then a challenge can be filed by initiating litigation or filing a complaint with the Department of Justice.

    CDA Practice Support offers additional resources to ensure practices are in compliance with disability access laws, including Best Defense Against Disability Lawsuits: Compliance. For more information on this resource and Americans with Disabilities Act and Disability Rights Law, visit cda.org/practicesupport.

  • Tobacco tax 'official' as Prop 56

    The secretary of state officially validated the tobacco tax measure for the November ballot on June 30 and announced that it will be Proposition 56. This is the result of efforts by the Save Lives California coalition, a partnership of health care and other organizations including CDA, which worked to get this life-saving initiative on the Nov. 8 statewide ballot.

  • Volunteer registration for CDA Cares is now open.

    Join us in Stockton and help us create thousands of stories of health and happiness for the community members who need it most.
    CDA Cares Stockton
    When: Saturday, Oct. 15 and Sunday, Oct. 16, 2016
    Where: San Joaquin County Fairgrounds, 1658 S. Airport Way, Stockton, CA 95206
    Put your compassion into action. Volunteer with colleagues, friends and family in Stockton this fall. Stay Connected
    © 2016 California Dental Association Foundation

  • HIPAA audits to expand in 2017

    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.

  • CURES Enrollment

    "CURES" Enrollment deadline in 2 days.