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Zona Hornstra, RDH, BS SDDHA Legislative Chair May 18, 2013 This is a Working Document and will be updated periodically with new information as it becomes.

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Presentation on theme: "Zona Hornstra, RDH, BS SDDHA Legislative Chair May 18, 2013 This is a Working Document and will be updated periodically with new information as it becomes."— Presentation transcript:

1 Zona Hornstra, RDH, BS SDDHA Legislative Chair May 18, 2013 This is a Working Document and will be updated periodically with new information as it becomes available

2 Describe Collaborative Supervision Practice Awareness of Level of Supervision Discuss Opportunities for Direct Access Review Specifics of SD Collaborative Agreement Laws and Regulations that regulate CS Identify Treatment Settings and Roles of Providers Documentation and Reporting Structures Determine an Awareness of SD Provider Shortage Areas Considerations for Business Planning and Tax Implications Reimbursement of Services/ CDT Codes Information of NPI numbers Location and Contact Info of State Public Access Opportunities Questions and Answers References

3 Collaborative practice means that the dental hygienist has established a written agreement with a dentist who has agreed to monitor treatment of patients and consult as needed. The dental hygienist and dentist jointly establish a protocol that describes the services the hygienist may provide without the dentist’s supervision.

4  The science of the prevention and treatment of oral disease through the provision of education, assessment, preventive, clinical, and other therapeutic services in a cooperative working relationship with a consulting dentist, but without general supervision. Christine Nathe RDH MS, University of New Mexico

5 LEVELS OF SUPERVSION "Direct supervision," the supervision of a dental hygienist or dental assistant requiring that a dentist diagnose the condition to be treated, a dentist authorize the procedure to be performed, a dentist remain in the dental office while the procedures are performed, and before dismissal of the patient a dentist has approved the work performed by the dental hygienist or dental assistant; "General supervision," the supervision of a dental hygienist requiring that a dentist authorize the procedures to be carried out, and that the patient to be treated is a patient of record of the supervising dentist and has had a complete evaluation within the previous thirteen months of the delegation of procedures; "Indirect supervision," the supervision of a dental hygienist or dental assistant requiring that a dentist authorize the procedure and a dentist be in the dental office while the procedures are performed by the dental assistant or dental hygienist Source: SD Dental Practice Act p. pg

6 Direct access dental hygiene practice options are available that would offer you:  a professional challenge  open doors to new opportunities  provide unique satisfaction  Being able to provide services to people unable to obtain them Collaborative practice can be a new career option:  as a part-time vocation  on an occasional volunteer basis

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8 Private dental office remains the primary place of employment. Career opportunities from alternative clinical setting to school sealant program. Career pathways in public health and career opportunities outside of private practice. ADHA give career opportunities in public health and `other opportunities. Information about specific job opportunities can be found in ADHA’s Career Center within the ADHA. org website

9 Dental hygiene was created as a distinct profession positioned in dental public health model in schools. Wide access to preventive care is provided by educated dental hygiene professionals in public settings in Early 1900’s. Emphasis was placed on the dental hygienist as an outreach worker to bring patients in need of restorative dental care. The effectiveness of the care provided in communities and schools spread to the private dental practice. Nation's health care leaders are quickly realizing the important connection between oral health and total health. Emphasis by both dental hygienists and dentists is now wisely being placed on interdisciplinary health care delivery options. One of the top ten fastest growing health professions in the country, *** References:  *** American Dental Hygienists' Association. July 10, ADHA Offers Testimony at CMS National Dental Medicaid Dental Town Hall Forum. Accessed July 16, 2010 from

10 2002 Oral Health Coalition recommended Limited Access Permit RDH was brought in as a Bill and was not approved in Committee Oral Health Coalition recommended investigation of a model of Public Health Supervision. Surgeon General mandates each state to have options for improved dental access. SDDHA brought forth House Bill 1045 which was Established by Statute in 2011 to allow dental hygienists to provide preventative services. Rules and statute put into SD Dental Practice Act July 2012.

11 The intent of collaborative dental hygiene practice is to:  Extend dental hygiene services to those unable to access services  Offering services in locations where there are transportation barriers There are many possibilities for a variety of locations and populations

12  The process of Collaborative Supervision practice agreement is defined by South Dakota law.  Dental hygienists and dentists must enter into a written collaborative agreement.  Collaboration will negotiate all details and protocols (e.g., billing practices and where and when dental exams occur)  Purpose of the written agreement is to clarify and document mutual decisions regarding specific dental hygiene services.  Details discussed and direction given within the SD Dental Practice Act.

13 DENTAL AND DENTAL HYGIENE  Knowing the laws governing dental hygiene and more specifically dental hygiene services in community settings is essential for all involved in Collaborative Supervision hygiene services.  The SD Dental Practice Act gives a complete picture of regulations addressing all aspects of dental care in South Dakota for regulations of dentists and dental hygienist, including Collaborative Supervision:  Under Statutes and Rules Review:  Title 36 : 36-6A-26, 36-6A-31; 36-6A-40; 36-6A-40.1  Title 20 Article 43/ 20:43:04:04; 20:43:10

14 36-6A-40. Employment of hygienist--Scope of permitted practice--Preventive and therapeutic services. Any licensed dentist, public institution, or school authority may use the services of a licensed dental hygienist. Such licensed dental hygienist may perform those services which are educational, diagnostic, therapeutic, or preventive in nature and are authorized by the Board of Dentistry, including those additional procedures authorized by subdivision 36-6A-14(10). As an employee of a public institution or school authority, functioning without the supervision of a licensed dentist, a licensed dental hygienist may only provide educational services. May not include the establishment of a final diagnosis or treatment plan for a dental patient. Services performed under supervision of a licensed dentist. and all care rendered by the hygienist is completed under the definition of patient of record. A dental hygienist may perform preventive and therapeutic services under collaborative supervision if the requirements of § 36-6A-40.1 are met. However, no dental hygienist may perform preventive and therapeutic services under collaborative supervision for more than thirteen months for any person who has not had a complete evaluation by the supervising dentist.  Source: SD Dental Practice Act

15 36-6A-40.1 Hygienist requirements for preventative and therapeutic services under collaborative supervision. A dental hygienist may provide preventive and therapeutic services under collaborative supervision of a dentist if the dental hygienist has met the following requirements: (1) Possesses a license to practice in the state and has been actively engaged in the practice of clinical dental hygiene in two of the previous three years; (2) Has a written collaborative agreement with a licensed dentist; and (3) Has satisfactorily demonstrated knowledge of medical and dental emergencies and their management; infection control; pharmacology; disease transmission; management of early childhood caries; and management of special needs populations.  Source: SD Dental Practice Act pg. 19

16  The Collaborative Agreement is designed as a guide for dental hygienists, dentists and facilities that are establishing dental hygiene services in community settings.  Laws pertaining specifically to Collaborative Supervision for dental hygienists are found in Chapter 10 of the South Dakota Dental Practice Act.

17 SD PRACTICE ACT CHAPTER 20:43:10 COLLABORATIVE SUPERVISION 20:43:10:01. Practice settings. A dentist may provide collaborative supervision to a dental hygienist pursuant to a collaborative agreement if the dentist holds a license in good standing in the state of South Dakota and the following services are provided: (1)In a school as defined in § 24:43:01:01(38); (2) In a nursing facility as defined in SDCL ; (3) Under the auspices of a Head Start program or Early Head Start program being operated by an agency designated pursuant to section 641 or 645A of the Head Start Act; (4) Under the auspices of a mobile or portable dental unit operated by any nonprofit organization affiliated with a nonprofit dental service corporation organized under SDCL chapter 58-39; (5) Under the auspices of a community based primary health care delivery organization, which is operating as a community health center or migrant health center, receiving funding assistance pursuant to section 329 or 330 of the United States Public health Service Act; (6) Through a program administered by the South Dakota Department of Health; (7) Through a program administered by the South Dakota Department of Social Services ; (8) Through a program administered by the South Dakota Department of Human Services ; or (9) Through a program administered by the South Dakota Department of Correction s. Source: SD Dental Practice Act pg. 65

18 Nursing home, home health agency Nursing facility as defined in SDCL Group home serving the elderly, disabled, or juveniles State-operated facility licensed by the commissioner of human services or commissioner of corrections Federal, state, or local public health facility Community clinic United States Public Health Service Act section 329 or 330 Tribal clinics- have their own requirements and contractual agreements that need to be met School authority In a school as defined in § 24:43:01:01(38) Head Start programs Mobile Units SDCL chapter NONPROFIT DENTAL SERVICE PLANS (Delta Dental Ronald McDonald bus, van)

19 24:43:10:02. Qualifications A dental hygienist providing services under collaborative supervision must hold a license in good standing in the state of South Dakota and meet the following requirements: (1) Completion of three years of clinical practice in dental hygiene; and (2) Completion of a minimum of 4,000 practice hours. A minimum of 2,000 of those hours must have been completed within two of the three years preceding application. 20:43:10:03. Application for registration. A dental hygienist registering to provide services under collaborative supervision must submit the following: (1) A completed application form; (2) A completed board approved collaborative agreement; (3) A fee of $20; (4) Verification of completion of three years of clinical practice in dental hygiene; (5) Verification of completion of a minimum of 4,000 practice hours; and (6) Verification of completion of a minimum of 2,000 practice hours within two of the three years preceding application. Source: SD Dental Practice Act pg. 67

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24 (2) A dental hygienist providing services under collaborative supervision may provide all preventative and therapeutic services that a hygienist is allowed to provide pursuant to SDCL chapter 36-6A and this chapter, except for the administration of local anesthesia and nitrous oxide inhalation analgesia, and must: (a) Maintain appropriate contact and communication with the dentist providing collaborative supervision; (b) Practice according to age and procedure specific standing orders as directed by the supervising dentist, unless otherwise directed by the dentist for a specific patient; (c) Provide to the patient, parent, or guardian a written plan for referral to a dentist land assessment of further dental treatment needs; (d) Have each patient sign a consent form that notifies the patient that the services that will be provided do not take the place of regular dental checkups at a dental office and are meant for people who otherwise would not have access to services; and (e) Specify a procedure for creating and maintaining dental records for patients that are treated by the dental hygienist, including where these records are to be located; Source: SD Dental Practice Act pg. 68

25 (3) A copy of the collaborative agreement shall be filed with the board. If any changes are made to the collaborative agreement, an updated copy of the agreement shall be filed with the board and must be approved; (4) If the agreement is terminated by the dentist or dental hygienist, the board shall be notified in writing within 30 days. A termination of the collaborative agreement constitutes a suspension of the registration (5) The collaborative agreement must be maintained by the dentist and the dental hygienist in each location where collaborative supervision is provided and must be made available to the board upon request. The dentist and dental hygienist must review the agreement annual 20:43:10:06. Termination of agreement. If any provision of the collaborative agreement is violated, the registration may be suspended or revoked by the Board. Source: SD Dental Practice Act pg. 68

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28 20:43:10:04. Collaborative agreement. A dentist and dental hygienist shall enter into a written board approved collaborative agreement that specifies the following responsibilities: Provide appropriate communication and consultation with the dental hygienist; Have age and procedure specific standing orders for the performance of dental hygiene services. Must include consideration for medically compromised patients and medical conditions for which a dental evaluation must occur prior to the provision of dental hygiene services; Specify no more than 13 months, examination must occur prior to providing further hygiene services. Limit the number of dental hygienists that he or she has a collaborative agreement with to four or less; S Source: SD Dental Practice Act: pg. 67

29 The law does not require the dentist to examine or treat people The document formalizes the working relationship Hygienists may have more than one sponsoring dentist if they are providing services in different community sites. If hygienists change sponsoring dentists, they must complete a different form, and resubmit to the SD Board of Dentistry.

30 20:43:10:05. Reporting requirements. Each dental hygienist must complete a summary report and submit the information to the board at the completion of a program or, in the case of an ongoing program, annually.

31 Form given to Collaborating Team after application is approved by State Board of Dentistry. SD Collaborative Supervision Reporting Form : Is an Annual requirement Requires begin and end dates of the Services provided. Requires a one specific location where treatment was given Requires tabulation of preventative treatment given per age group Requires tabulation of Regular or Urgent referral given per age group Form will specify and document one location per form. Form copy is to be maintained by Collaborating by Hygienist and Dentist and also sent to the SD State Board of Dentistry.

32 https://www.sdboardofdentistry.org State Board of Dentistry site: Licensure tab Application/ Documentation General tab  Bottom of page  Collaborative Supervision Agreement Consideration to make this info more visible to Dentists

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34 Utilize a public health programming model: Define the Target Population Formulate the Problem Statement Perform a “Needs Assessment”  % of people who need care, have teeth, neglected Access To oral health care Create a Logic Model  Collaborative Supervision Model

35 Secure your collaboration with a dentist, discussing an effective referral and/ or follow through mechanism, i. e. dental home Design plans in collaboration with the intended agency/ facility/ population Interview dental hygienists and dentists currently involved with collaborative practice Formulate a business plan with Collaborating DDS Utilize the Dental Safety Net Clinic Manual

36 Safety Net Dental Clinic Manual Welcome to Safety Net Dental Clinic Manual, which is designed to help safety net dental clinic staff with all aspects of clinic development and ongoing operations. Chapter 1: Partnerships & Planning Chapter 2: Facility Design & Staffing Chapter 3: Finances Chapter 4: Clinic Operations Chapter 5: Quality Improvement Chapter 6: Program Sustainability

37 Collaborating Dentist Facility Based Opportunity for Grants HRSA, ADHA

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39 Q: How is a dental hygienist paid; how is a program financed? A. Various options, to include : As an employee of a dentist, submit claims through the dental office  Fee-for for-service; Sliding fee scale  Grant funding  Philanthropic donations; funding from Foundations  FUTURE POSSIBLITIES  Medicaid direct billing utilizing the RDH’s NPI numbers  Health plan billing utilizing the RDH’s NPI numbers

40 Private insurance companies may reimburse dental hygienists in some states. Need to consider coordinating billing through the Collaborating dentist. Some might limit the codes they will reimburse to dental hygienists. To order the CDT manual of dental codes see:

41 ADA determines CDT codes (Current Dental Terminology) Responsibility of a Code Maintenance Committee (CMC). Mission is to incorporate best practices from HIPAA, CDT, ICD-9 codes. Provisioned for Affordable Health Care Act

42 CODES FOR DIRECT ACCESS  Pre-diagnostic Services  D0190 Screening of a Patient to determine need to be seen by a Dentist  D0191 Assessment of Patient – a limited inspection to determine need for referral for diagnosis and treatment D Capturing radiographic image without interpretation  D0391 Image captured by practitioner not associated with interpretation or report. D1206 topical application of fluoride varnish  D1208 topical application of fluoride Source: Department of Human Services April 2013

43 Caries management by risk assessment  A methodology of identifying the cause of disease through the assessment of risk factors  This approach has been qualified through various experts, researchers and advocated by numerous professional organizations  Become a new standard of care which should be incorporated into the dental hygiene process of care ADA has approved 3 New CAMBRA CDT codes for 2014 book Source:

44  Along with assessment forms, suggested management protocols and clinical guidelines:  0-5 years of age:  Frequency of periodic examination  Frequency of radiographs  Saliva testing  Fluoride Utilization (in-office, daily use and care giver)  Xylitol products  Sealants  Antibacterials  Anticipatory guidance/counseling  Self management goals  White spot precavitated lesion management  Restoration/Existing lesions   5 through Adult(5):  Frequency of radiographs  Frequency of caries recall exams  Saliva test (saliva flow & bacterial culture)  Antibacterials, chlorhexidine & xylitol  Fluoride (in-office & daily use)  pH control  Calcium phosphate topical supplements  Sealants

45 Governor Daugaard decided not to fund Medicaid Expansion this last legislative session But A task force developed to gather information determine the best decision for SD. Meetings to be held Spring/ Summer 2013 with a report to the Governor September Can Find more info at:

46 Total individuals eligible in Fiscal Year 2010 = 96, % of children enrolled in Medicaid accessed preventive dental services (37,353 eligible) 17.6% of children enrolled in Medicaid received dental treatment services (17,032 eligible) 5.1% of children enrolled in Medicaid received a sealant on a permanent molar tooth (4,951 eligible) Total eligible receiving any dental services= 41,271 (42.6%) Total eligible receiving dental diagnostic services= 34,815 (35.97%) Total eligible receiving oral health services provided by a non-dentist provider = 287 (0.3%) Total eligible receiving any dental or oral health services= 41,460 (42.8%)

47 Based on four indicators as a key part of any state’s prevention strategy:  having sealant programs in high-need schools,  allowing hygienists to place sealants in school-based programs without requiring a dentist’s exam,  collecting data regularly about the dental health of school-children and submitting it to a national oral health database, and  meeting a national health objective on sealants.

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50 Each state Medicaid program is Federally mandated and identifies the types of procedures and providers it reimburses for services. Federal / State Medicaid Assistance Percentage is decided on matching funds based on 3yr income average of each state. SD Privatized Medicaid by contracting with Delta Dental to administrate the program. Medicaid in other states will reimburse dental hygienists who provide care if alternative settings for: prophylaxis, sealants, and fluoride with improvement on reimbursement due to new CDT codes. SD currently does not allow Medicaid reimbursement to dental hygienists but does reimburse medical providers and others for fluoride application. Many rules and stipulations dependent on age and inability to pay programs determine reimbursement under Medicaid program. Utilize Call center to determine eligibility: Call Center Fax Back or deltadentalsd.com

51 OTHER LAWS APPLICABLE TO COLLABORATIVE HYGIENE SERVICES Health Insurance Portability and Accountability Act (HIPAA)- every health care provider, regardless of size, who electronically transmits health information in connection with certain transactions, is a covered entity.  These transactions include claims, benefit eligibility inquiries, and referral authorization requests.  The Office of Civil Rights and US Department of Health and Human Services offers a full range of easily understood explanations of HIPAA regulations.  You may need to have patients sign a Notice of Privacy Practices.  Decision Matrix for HIPAA: Online “test” to determine if a specific Collaborative Supervision services qualifies for coverage. 

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53 In order to file an electronic claim to a third party payer, whether private insurance or Medicaid, you need your own National Provider Identifier (NPI). An NPI is a 10 digit number, assigned for free by the federal government, that serves as a permanent identifier of you as a healthcare provider, even if you move or are relicensed in a different profession. Good idea to apply for the free NPI even if you do not bill third parties directly you can apply anyway because it may facilitate billing actually submitted by a health department or other entity for services that you provided. For more information about the NPI and how to obtain one, please visit the NPPES website or https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward =static.npistart or contact NPPES directly by phone at (800)

54 Possibilities to Discuss within the Agreement: Obtain Wage from Collaborating Dentist Self- Employed and Contract Basis Receive Percentage of Services Provided If Medicaid, DDS is willing to submit CMS 416 (Medicaid form for reimbursement) Volunteer Basis

55 Tax Implications of employment status under: Self-employment  IRS self-employment tax- (quoted from IRS)  If the hygienist is reimbursed for her services as an independent contractor, rather than an employee with taxes takes out, the IRS will expect regular “self-employment” taxes and hygienist may be responsible for paying your own social security and federal and state income taxes directly to the government.  Check with IRS website and an accountant to determine if expenses incurred in a Collaborative Agreement volunteering in community settings are tax deductible.

56 Why you need professional liability insurance! Insurance coverage held by the employer is written to protect the employer and patients served by the employer. Individual employees have limited protection and limited access to the legal defense services provided to the policy holder. If you are self-employed you need individual protection for yourself and your business even more so. Insurance protects hygienists and Collaborative Supervision sites against claims made in conjunction. Please discuss CS intent with Insurance agent! Professional liability insurance coverage is generally restricted to matters relating to patient care - it will not cover loss or damage to equipment, general negligence issues or other matters. ADHA offers great information on professional liability and other types of insurance for self-employed dental hygienists, as well as equipment replacement insurance at: https://www.personal-plans.com/adha/welcome.do

57 Two sources to explore: Marsh Affinity Group Services https://www.proliability.com/ahc/homePage.do? PromoReqCode=googledenthyg1 Health Providers Services Organization (HPSO)

58  It is in addition to whatever coverage hygienists may have with employers.  Hygienists in a self-employed environment, should carry professional liability coverage self- employed and employed situations.  The insurance application has a section for checking off both types of employment.

59 Coverage for damage, loss and theft of equipment, tools and supplies  Laws governing Collaborative Supervision do not require the hygienist to have insurance covering damage and loss of instruments and equipment.  It is wise to make sure that loss or theft of supplies, instruments and equipment are insured. Most insurance companies offering homeowners and renters insurance can advise on the type of coverage and cost to cover business equipment.  OPTION: Lockton Insurance: ins.com/pl

60 Manual Overview Chapter 1 - Introduction/Planning Chapter 2 - Mobile Dental Systems Chapter 3 - Portable Equipment Chapter 4 - Mobile-Portable Hybrid Chapter 5 - Measuring Effectiveness and Outcomes VERY GOOD SOURCE TO REVIEW AND PICK OUT ITEMS THAT BE BENEFICIAL TO YOU IN YOUR AGREEMENT!

61  Various methods of service delivery Portable dental equipment (e. g. Aseptico Dentlworks)  Mobile vans, trucks  Stationary equipment in schools  Stationary equipment in long term care or other facilities

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63 The Association of State and Territorial Dental Directors (ASTDD) is a national non-profit organization representing the directors and staff of state public health agency programs for oral health. ASTDD formulates and promotes the establishment of national dental public health policy, assists state dental programs in the development and implementation of programs and policies for the prevention of oral diseases; builds awareness and strengthens dental public health professionals' knowledge and skills by developing position papers and policy statements; provides information on oral health to health officials and policy makers, and conducts conferences for the dental public health community.

64 MMWR Report CDC GUIDELINES FOR INFECTION CONTROL FOR DENTAL SETTINGS Also available is a Training Power point for Employees

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66 Occupational Safety and Health Administration (OSHA) Web site: Regulatory agency within the federal government. "Safety and Health Issues" are listed the "Blood Borne Pathogen Standard," the "Needlestick Injury Rule," and the "Ergonomics Standard. “ Organization for Safety and Asepsis Procedures (OSAP) Web site: OSAP is a non-profit organization whose mission is dedicated to promoting infection control and related science based health and safety policies and procedures and training information.

67 ADHA’s Standards for Clinical Dental Hygiene Practice:

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69 Community Health & WIC Community Health & WIC Office of Family and Community Health Services (Public Health Alliance Sites Included)  WIC services available at all offices.  Offices are listed by county  offices/CHS

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71 South Dakota Head Start Program Availability by Area. Detailed program descriptions below. Program/GranteeHead StartEarly Head Start Phone BadlandsXX Cheyenne River Sioux Tribe X Crow Creek RAI Dakota Site XX Inter-Lakes Community Action XX Lower Brule Sioux TribeX Northeast South DakotaX Oahe Child Development Center XX Oglala Lakota CollegeXX Rosebud Sioux TribeX

72 South Dakota Head Start Program Availability by Area. Detailed program descriptions below. Program/GranteeHead StartEarly Head Start Phone BadlandsXX Cheyenne River Sioux TribeX Crow Creek RAI Dakota SiteXX Inter-Lakes Community ActionXX Lower Brule Sioux TribeX Northeast South DakotaX Oahe Child Development Center XX Oglala Lakota CollegeXX Rosebud Sioux TribeX

73 Rural America Initiatives Lakota Site XX Sioux FallsX Sisseton/Wahpeton Sioux Tribe XX South Central Child Development X Standing Rock Sioux Tribe XX University of South Dakota XX Yankton Sioux TribeX Youth & Family Services XX

74 SD Federally Qualified Health Centers Bennett County Family Health Center PO Box 70 D Martin, SD Phone: (605) Fax: (605) Web: DeSmet Dental Services PO Box 49, 801 Third St. SW DeSmet, SD Phone: (605) Web: Howard Community Health Center PO Box 99, 208 South Main Street Howard, SD Phone: (605) Fax: (605) Web:

75 Rapid City Community Health Center 504 East Monroe Street Rapid City, SD Phone: (605) Fax: (605) Web: Falls Community Health 132 North Dakota Sioux Falls, SD Phone: (605) Fax: (605) Web: Jerauld County Dental Clinic 602 1st Street NE Suite 2 Wessington Springs, SD

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77  Who is “liable” for acts of commission or omission by the dental hygienist even if the RDH has liability insurance?  Does the dentist “have to” incorporate the patients seen by the dental hygienist as patients of record?  How are dental hygienists reimbursed and is it financially feasible for the collaborating dentist?

78 Q. How do I find a dentist to sponsor me for an Collaborative Supervision? A successful professional relationship has respect and trust at its foundation. These are the ingredients for all partnerships, teams, and professional/client relationships. You can begin by asking a dentist you have worked with. As an alternative, consider seeking out a dentist who demonstrates a commitment to public health dentistry: someone working at a public health clinic, volunteering in community projects, or serving patients covered by Medicaid.

79 Q. What do I say to a dentist who might collaborate? A. If you are just starting to explore the benefits of having an agreement, you could simply ask dentists if they have considered sponsoring hygienists. You can prepare for the conversation by listing the basic requirements of the agreement. Here’s one way of introducing the topic: I have begun looking into a Collaborative Agreement, but I am just at the stage of exploring how it might fit into professional practice. I have a lot of research to do but one stipulation is having a dentist to sponsor me. Would you be willing to talk with me about your interest in and questions about being a sponsoring dentist? Since you are clear that you are just exploring it yourself, you provide the dentist with a graceful exit.

80 Q. What do I say after the dentist says, “Sure lets talk. What is the role of a sponsoring dentist?” You can begin with the statute of South Dakota Legislature and referring to the SD Dental Practice Act (Ch 10). This includes a signed agreement stating the dentist shall monitor the dental hygienist's activities. Read the entire statute before your discussion and have a copy of the statute with you for reference.

81 The Working column in Access magazine highlights on dental hygienists who have pursued a variety of career paths:

82  Infection Control/Medical Info Ready Reference Web Site Resources Fact Sheet  Listed here are sites to locate guidelines and information on clinical topics and issues of interest to the dental hygienist and the oral health care profession.  American Dental Hygienists' Association (ADHA) Web site: The national association Web site offers definitive information about the profession of dental hygiene including a list of all dental hygiene education program; a career resource center; association position papers; and timely, relevant articles. Join on line if you are not already a member!www.adha.org  American Heart Association (AHA) Web site: www. heart.org/ HEART ORG/Conditions This site contains the 1997 guidelines for prevention of bacterial endocarditis. Located under the "Diseases and Conditions" section, select "Other" to locate the comprehensive guidelines and other heart-related information.  Centers for Disease Control and Prevention Web site: This site contains a wide range of health-related information. Examples include "Infection Control Guidelines released in1998 and found under "Issues in Health Care Settings" and the "Guideline for Hand Hygiene in Health Care Settings" released in Other valuable sections are the "Fluoride Recommendations" and the Office of Smoking and Health.http://www.cdc.gov  Web site: For information on latex allergies, use the National Institute of Occupational Safety and Health through the CDCwww.cdc.gov/niosh

83  Journal of Cancer Web site: A free online resource journal about cancer treatment and prevention for clinicians.http://www.amcancersoc.org/  National Institutes of Health Web site: This site provides the gateway to all of the individual groups that comprise the National Institutes of Health. While all are of interest, there are several that may be very useful. From the homepage, scroll down to "Institutes, centers and offices." Here is a selection of listings based on areas of current interest and which are particularly useful for dental hygienists.www.nih.gov  National Institute for Dental and Craniofacial Research  The National Oral Health Information Clearinghouse, a service of the NIDCR, contains, is a resource for data on special care patients.  National Heart. Lung and Blood Institute  National Institute of Arthritis and Musculoskeletal and Skin Diseases  National Institute of Diabetes, Digestive, and Kidney Diseases  National Center for Complimentary and Alternative Medicine  National Library of Medicine Web site: A division of the National Institute of Health, the National Library of Medicine allows access to the MEDLINE/PubMed, one of the best sources for health care literature. Once in the site, choose "Health Information " and then, MEDLINE/PubMed. This will provide references and abstracts from more than 4000 journals.www.nlm.nih.gov

84 SPECIAL THANKS TO: Clare Larkin, RDH MEd RF CDHC Normandale Community College FORMS OBTAINED FROM: SD State Board of Dentistry IA State Board of Dentistry ADHA Career Options Toolkit


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