Legislation and Rules That Affect Orthodontic Practice in California

• Reg's on Registered Orthodontic Assistant (ROA) Delayed
• Coronal Polishing and X-Ray Training Required for RDA’s
• Dental Board Approves Sterilization Regulations
• New Dental Materials Fact Sheet Not Required
• HIPAA Update
• Prop 65 Requirements Relaxed
• CDC Guidelines for Infection Control

News of Legislation and Regulations:

CAO Efforts to Change Infection Control Regs

For several years, CAO has been working to modify the state regulations on sterilization of instruments.  No doubt you know how onerous recent changes in the current regs have been to assimilate into your practice.

We believe we finally have an opportunity to initiate important changes in these regs and your participation could be critical to our success.  On Nov. 13-15 he Calif. Dental Board will hold hearings in Sacramento about this issue.  Attached is a position paper we have developed and which will be considered by the Dental Board Infection Control Committee at the Nov. meetings.

Several CAO leaders will be present at the meetings.  However, participation by other CAO practicing orthodontists and their staff will be very important in convincing the committee members of our position.

If you are interested in participating, please respond and I will add you to a list of members committed to attend; see response form at the bottom of this message.  For those of you who do respond, I will be in touch with you when we know the exact meeting schedule and Sacramento location.  Your attendance, and that of your staff, for just one day will be very crucial to our efforts.

Thanks for your consideration.

Phillip Rollins, CAE
Executive Director
California Association of Orthodontists
415-675-4500/415-441-5683 Fax
P.rollins@mra-sf.com

Reg's on Registered Orthodontic Assistant (ROA) Delayed

Recent talks between numerous dental organizations, including CAO, working to develop regulations governing the training of ROA’s and other specialty assistant categories, have concluded that a final agreement that would allow existing dental assisting education programs to conform to new standards could not be reached by the January 1, 2007 legislative deadline.

We expect legislation to be approved that postpones that deadline to January 1, 2008.

For much of this year, CAO leaders have been working with CDA, the dental assistant alliance, the Committee on Dental Assistants (COMDA), and the Dental Board regarding a new specialty assistant training curriculum.

In early negotiations, on-the-job training (OJT) was eliminated as an educational pathway.  Since that time, with the insistence of a number of dental specialty groups including CAO, the “in-office” educational model has been reconsidered as a training option. CAO continues to insist on this alternative training pathway.

The school-based program proposed by the assisting community relies primarily on didactic and pre-clinical education, with less emphasis on practical experience.

Overall, CAO has proposed the implementation of regulations that will define the education and training requirements necessary to achieve minimum competence in the duties a registered orthodontic assistant is authorized to perform. Such an approach takes into account the combination of didactic and practical instruction, clinical training, and supervised work experience, that when taken together are most likely to provide the greatest number of opportunities for improving dental assisting skills efficiently.

“The goal is to encourage entrance into the dental profession, create a career ladder, redesign the education and training to be responsive to the contemporary practice of dentistry, maximize office productivity, and reduce the need for dentists to provide additional training to assistants” said Cathy Mudge, assistant vice president of CDA Public Policy.

Those who achieve RDA status before January 1, 2007 will be allowed to perform all specialty assistant duties, with a few exceptions that will require additional training, including the selecting, pre-positioning, curing, and removing of brackets. And those seeking ROA status will be required to successfully complete the ROA training and not the standard RDA courses.

After Jan. 1, 2007, those seeking RDA status will be required to complete the training programs that teach all the new duties for each specialty assistant category. Again, those seeking ROA category will only be required to complete the ROA training and not that for the RDA.

The project of developing specialty assistant categories began about ten years ago when COMDA started a state mandated review of dental assisting. Little progress was made over the years until scope of practice legislation was passed in 2002 and discussions began shortly thereafter about specialty dental assisting categories.

CAO leaders believe the new ROA program has the potential to increase the pool of qualified orthodontic staff, which will positively affect access to dental care. However, the debate over the regulatory language will ultimately decide the likelihood of this increased orthodontic (and other specialty) staff availability.

Assuming the deadline is postponed to January 1, 2007, training programs will begin accepting students soon after that date. Although we expect training to be available in early 2007, the Dental Board will not be able to issue licenses for the specialty assistants until January 2008.

Check the CAO website for the most current information: www.caortho.org.

More on RDA Licensure Requirements.

Coronal Polishing and X-Ray Training Required for RDA’s

According to the Committee on Dental Auxiliaries, beginning January 1, 2006, those with RDA licenses will be required to produce proof of x-ray and coronal polishing training in order to renew those licenses.  Licenses will not be renewed without proof of this training.

Such proof for coronal polishing training must be:

1. coronal polishing training sticker on license (none were ever issued for x-ray training, or

2. certificate or other documentation from institution of training, or

3. letter of affidavit from instructor who taught training.

Proof of x-ray training must be:

1. certificate or other documentation from institution of training, or

2. letter of affidavit from instructor who taught training.

A list of training courses may be viewed on the COMDA website at http://www.comda.ca.gov/courses.html.

Sterilization Regulations Approved

Current California Dental Board regulations require that critical and semi-critical instruments or containers of critical and semi-critical instruments sterilized by a heat or vapor method shall be packaged or wrapped before sterilization if they are not to be used immediately after sterilization. Such packages or containers shall remain sealed unless the instruments within them are placed onto a setup tray and covered with a moisture impervious barrier on the day the instruments will be used and shall be stored in a manner so as to prevent contamination.

Infection control regulations are reviewed by the Dental Board annually, and CAO will continue to advocate for more meaningful regs.

See more on sterilization requirements or download the regulations.

New Dental Materials Fact Sheet Not Required

The current version of the updated “consumer friendly” restorative materials fact sheet was approved by the Dental Board in 2004. However, distribution of the from to patients is only required for restorative procedures.

More on the Dental Materials Facts Sheet.

Download the Fact Sheet in English, Spanish or Chinese, plus instructions for distribution.

HIPAA

A recent federal district court has upheld the final version of The Health and Portability and Accountability Act, which allows health care services covered by the rules to disclose patients' protected health related information for routine purposes without obtaining consent.

We anticipate this should give orthodontists more flexibility regarding their ability to treat patients without worrying about first obtaining consent.

Many covered entities expressed concerns about the timely delivery of health care under the original rule. Unintended inefficiencies are the basis of this decision.

Attorney General Relaxes Proposition 65 Requirements

In the Spring of 2004, three years after our initial efforts on this issue began, the California Attorney General confirmed that orthodontists are not required to post the Proposition 65 sign regarding nickel and chromium.

However, we recommend that CAO members review Prop 65 identified materials frequently to be certain that none of the listed materials are being used.

See our Prop 65 update or the California Office of Environmental Health Hazard Assessment information on Prop 65.

Summary of CDC Guidelines for Infection Control in Dentistry

The Center for Disease Control and Prevention (CDC) released new guidelines for infection control for dentistry on December 19, 2003 - 10 years after the previous update of such guidelines.

Download a summary of how the new CDC guidelines may effect California orthodontists (PDF- 37KB).

You can view the full 68 page guideline at: www.cdc.gov/OralHealth/infectioncontrol/guidelines/index.htm.

Next: Status of Legislation and Regulations