23 April 2008 Weather Coalition Priorities The Weather Coalition.
Considerations for school districts for dental services in ......seeking guidance from the...
Transcript of Considerations for school districts for dental services in ......seeking guidance from the...
Considerations for school districts for dental services in the school setting
May 2011
1
• Isthemobiledentalfacility,orportabledentalunit,registeredwiththeTexasStateBoardofDentalExaminers(SBDE)asrequiredbySBDERule§108.40?1
To check registration-http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=123&Itemid=26
SBDE Rule §108.40 http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=22&pt=5&ch=108&sch=D&rl=Y• Havealltreatingdentistsandalliedteammembers(dentalhygienistsanddentalassistants)presentedcopiesof
theirprofessionallicensesorrequiredcertification/registration?1
To verify licensing - http://www.tsbde.state.tx.us/index.php?option=com_content&task=section&id=6&Itemid=38• Arethelicensesandcertifications/registrationsvisiblypostedinthemobileunitorwherethedentalprofessionals
aretreatingthechildren?1 SBDE Rule §108.43 http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=22&pt=5&ch=108&sch=D&rl=Y• Isthemobiledentalfacility,orportabledentalunit,displayingtheconsumerinformationsignasrequiredbythe
SBDE?1 SBDE Rule §108.3 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_
ploc=&pg=1&p_tac=&ti=22&pt=5&ch=108&rl=3• Haveallcontracteddentistspresentedcopiesofanyrequisiteanesthesia/sedationpermits?1
SBDE Rule Chapter 110 Sedation and Anesthesia http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113• Haveallalliedteammemberspresentedcopiesofanyrequisiteexpandeddutycertificates?Certificatesmay
includethoserequiredfortakingx-rays,placingpitandfissuresealants,nitrousoxidemonitoring,andcoronalpolishing.1
SBDE Rules §114.2, §114.3, §114.4, §114.5, §115.2 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113
Considerations for school districts for dental services in the school settingTheseconsiderationsarebasedonrequestsbylocalschooldistrictsseekingguidancefromtheChildren’sOralHealthCoalition(COHC)torespondtomobiledentalcompanies,offeringtoprovidedentalservicestothechildrenintheirdistricts.TheseconsiderationsareofferedbyCOHCinthespiritoffulfillingitsmissiontoimprovetheoralhealthofchildreninourcommunity.
Eachdistrictcanusetheseconsiderationsindevelopingtheir ownprocessforresponding.Thisis notanallinclusivelist.TheChildren’sOralHealthCoalitionisnotaregulatoryorlicensingorganizationandthoseprofessionalorganizationsindentistryareimportantresourcesfortheschooldistricts.The considerations listed below are intended as suggestions and do not constitute professional advice nor should it replace your professional judgment. As always, the COHC strongly encourages you to follow your district’s policies and seek legal guidance from your district’s attorney regarding any agreement. The links presented in this document are up to date as of May 2011.Pleasemakesureyouareviewingthemostcurrentversionofthelaw.
Documentation considerations
2
• Dothecontracteddentistsandalliedteammembershaveanydisciplinaryactionsagainstthem?1 For Disciplinary Action Information - http://www.tsbde.state.tx.us/index.php?option=com_content&task=section&id=6&Itemid=38• Isthemobiledentalfacility,orportabledentalunit,complyingwithallaspectsoftheHealthInsurancePortability
andAccountabilityAct(HIPAA)of1996(P.L.104-191)[HIPAA]?2 P.L.104-191http://aspe.hhs.gov/admnsimp/pl104191.htm• Hasthemobile/portableunitinformedtheschoolordistrictinwritingaboutthelimitationsofservicestheyintend
toprovide?• Hasthemobile/portableunitgiventheschoolordistrictwrittenproofofaprotocolforreferralincludingan
agreementwithlocaldentiststoprovidefollow-upandemergencycare?• Doesthemobile/portableunithaveaformalprocessfordatagatheringandrecordkeeping?• Arealloftheappropriateinformedconsentformspresentedtoandsignedbyparentspriortotreatingthe
children?Examplesofnecessaryconsentformsinclude–HIPAA,Consentfortreatment,Consentforspecificrestorativetreatment,ConsentforNitrousOxidetobeused,etc
• Istherea24houremergencycontactphonenumberprovidedbythemobile/portableunitfordentalemergencies?1
SBDE Rule §108.5 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113• Willthemobile/portableunitprovidetheschoolordistrictwiththedirectcontactnumberforthedentistwhoowns
thecompany?1 OnlyaTexaslicenseddentistmaylegallyownadentalpracticeinTexas.Thisincludesmobile/portableunits. Texas Occupations Code §251.003 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=108&Itemid=109• Whereistheofficeofrecordforthecompanyoperatingthemobile/dentalunit?1 SBDE Rule §108.43 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113• Istheschoolordistrict,andthecompanyoperatingthemobile/portableunit,awareoftheParental
AccompanimentrequirementforbillingMedicaid?3 HRC §§32.024(s)-(s-1) DSHS Rule §33.6 http://www.tmhp.com/HTMLmanuals/TMPPM/2010/2010TMPPM-23-06.html• Haveallemployeesofthecompanyowningthemobile/portableunit,whowillhavedirectcontactwiththe
childrencoveredunderthecontract/memorandaofunderstanding,undergonecriminalhistorychecksasrequiredbyTexasEducationCode§8.057?4
Texas Education Code §8.057 http://www.tea.state.tx.us/index2.aspx?id=5535&menu_id=840&menu_id2=79• Willtherebelanguagetranslationservicesprovidedbythedentalcompanyoperatingthemobile/portableunit?• Whatisrequiredfromtheschoolwhenamobiledentalcompanyispresent?• Whatistheschoolordistrict’sprofessionalliabilityinsurancerequirement?• Doesthedentalcompanyoperatingthemobile/portableunitintendtocomplywiththerequirementsgoverning
dentalx-rays?1 SBDE Rule §113.2 http://www.tsbde.state.tx.us/index.php?option=com_content&task=view&id=107&Itemid=113 Texas Administrative Code §289.232 http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_
ploc=&pg=1&p_tac=&ti=25&pt=1&ch=289&rl=232• Arethechildrenidentifiedwithanappropriatenametagoncetheyareinthemobileunittokeepthepatientand
theirrecordsidentifiedandtogether?• Howmuchtime(approximately)willachildbeoutofclasswhenbeingseenbythemobiledentalcompany?
3
Scope of care considerations• Whattypeofserviceswillthemobiledentalcompanybeproviding? - PreventiveServicesOnly–(i.e.screenings,exams,cleanings,sealants,fluoride,etc.) - PreventiveServicesandRestorativeServices(dentaltreatmentincluding,butnotlimitedto,fillings,rootcanals,
crowns,toothremoval,etc.)• Thereisadifferencebetweenascreeningandanexam.TherearealsorulessetbytheStateBoardofDentistry
regardingwhichdentalprovidersareallowedtodoscreeningsandexams.(seeattachedglossary) - Willthecompanybeprovidingscreeningsorexamsonthechildren? - Whowillbedoingthescreenings? - Whowillbedoingtheexams? - Whenwillradiographs(x-rays)betaken?• Ifrestorativeworkisbeingdonebythemobiledentalcompany,willtheparent/guardianbeallowedorrequiredtobe
presentforthetreatment?• Beforeanyrestorativeworkisdoneonthechild,willtheparentbegivenaninformedconsentwiththeirsignaturefor
consentpriortoanytreatmentbeingdoneonthechild?• Ifthemobiledentalcompanyprovidesrestorativeservices,wherewilltheybedone?(inthemobileunitattheschool
oratanoff-sitelocation?)• Howsoonwilltherestorativeservicesbedone?• Whatprocessorpolicydoesthemobilecompanyhaveforpatientstabilization,suchas
“papoosing”?DoesitmeettheAmericanAcademyofPediatricDentistryguidelines?5http://www.aapd.org/media/Policies_Guidelines/G_BehavGuide.pdf
Considerations for who will be seen• Whoisthetargetpopulationofthemobiledentalcompany? - Allchildren,eventhosewhoalreadyhaveanestablisheddentalhome(seetheattachedglossaryforthedefinitionof
adentalhome) - Childrenwhodonothaveanestablisheddentalhomeordentistofrecord? - ChildrenwhoonlyhaveMedicaid/CHIPcoverage? - ChildrenwhodonothaveMedicaid/CHIP,otherdentalinsurancecoverage,orpresentwithotherbarrierstoaccess
ofdentalcare?• Withthechildrenwhowillbeseenbythemobiledentalcompany,willallofthembeofferedandpresentedthesame
levelofcareandservicesdependingontheirindividualneedandnottheirMedicaidorinsurancestatus?• IfthemobiledentalcompanyadvertisesscholarshipsorgrantsforservicesrenderedonchildrenwithoutMedicaidor
CHIPcoverage, - Howmanystudentswillbeabletoreceivethesescholarships? - Whatlevelofcarewillthechildrenwithscholarshipsreceive? - Whatistheamountofthescholarshipcomparedtotheneededservices?• Willnon-studentsoradults,suchassiblingsorfamilymembersoftheschoolchildrenbeabletobeseenbythemobile
dentalcompany?
4
Referral information considerationsFor those mobile dental companies who provide preventive services only, the following considerations may apply.
• Whoisthemobiledentalcompanygoingtoreferthechildrento,whowereidentifiedasneedingtohaverestorativetreatmentdone?5http://www.aapd.org/media/Policies_Guidelines/P_Ethic.pdf
• Doesthemobiledentalcompanyhaveawrittenandsignedagreementwiththedentisttowhomtheyaregoingtoreferthechildren?
• Doesthemobiledentalcompanyhaveawrittenandsignedagreementwithatleasttwoseparatepediatricdentistsandoralsurgeonstoreferthosechildrenwhomayneedmoreextensivetreatmentduetotheiridentifieddentaldisease?
• DothereferralsourcesacceptMedicaidandCHIP?• Aretheofficesofthereferralsourceswithinareasonabledistanceforthefamilytoaccessservices?• Howaretheparentsnotifiedwhentheirchildneedsdentaltreatmentotherthanwhatthemobiledental
companyprovided?• Willtheparentsofthechildrenidentifiedasneedingemergencydentaltreatment,bemadeawarethattheir
childrenneedtobeseenassoonaspossiblebyadentist?• Willtherebeassistanceprovidedbythemobiledentalcompanytohelpparentsmakeanappointmentwiththe
referraldentistwhenthechildrenneedimmediatedentaltreatment?
Reporting/record keeping considerations• Istheschoolgivenareportcardfromthemobiledentalcompanystatinghowmanyprocedureswere
performedattheirschool?(i.e.howmanyscreeningsweredone,howmanysealantsweredone,howmanychildrenwerereferredtohaverestorativetreatmentdone,etc?)
• Willtherebealistofnamesprovidedtotheschoolregardingthosechildrenwhoareidentifiedwithpresentdentaldiseaseandneedtobeseenbythereferreddentist?
5
Glossary and other resourcesThe terms and resources provided are not an end all list of those terms used in the practice of dentistry, however they may be of assistance to you.
For further resources on dentistry and/or children’s dental health, please visit:
• TheAmericanAcademyofPediatricDentistry–www.aapd.org• TheAmericanDentalAssociation–www.ada.org• TheAmericanDentalHygienists’Association–www.adha.org• NationalMaternalandChildOralHealthResourceCenter-http://www.mchoralhealth.org/• TheAmericanAcademyofPediatrics-http://www.aap.org/healthtopics/oralhealth.cfm• TheTexasDentalAssociation-www.tda.org
Amalgam–Adentalfillingmaterialmadeofalloy.6
Bitewing-Atypeofdentalx-ray.
Calculus–Harddepositofmineralizedsubstance(hardenedplaque)thatstickstotheteethandhastoberemovedwithaprofessionalcleaning.Commonlyknownastartar.7
Caries–Commonlyusedtermfortoothdecay.6
Cavity–Missingtoothstructuremostcommonlycausedbytoothdecay.6
Composite–Adentalfillingmaterialmadeupofresinparticles.6
Deciduous teeth–Commonlyknownasprimaryorbabyteeth.
Dental Assistant-Dentalassistantsmustworkcloselywith,andunderthesupervisionof,dentists.Dentalassistantsmayperformavarietyofpatientcare,office,andlaboratoryduties.Theysterilizeanddisinfectinstrumentsandequipment,prepareandlayouttheinstrumentsandmaterialsrequiredtotreateachpatient,andobtainandupdatepatients’dentalrecords.Assistantsmakepatientscomfortableinthedentalchairandpreparethemfortreatment.Duringdentalprocedures,assistantsworkalongsidethedentisttoprovideassistance.Theyhandinstrumentsandmaterialstodentistsandkeeppatients’mouthsdryandclearbyusingsuctionhosesorotherdevices.Theyalsoinstructpatientsonpostoperativeandgeneraloralhealthcare.Dentalassistantsmaybetrainedonthejoborattendtrainingcoursesinprogramsthatmaylastanywherefrom4monthsto2years.7
Dental Home-Thedentalhomeistheongoingrelationshipbetweenthedentistandthepatient,allaspectsoforalhealthcaredeliv¬eredinacomprehensive,continuouslyaccessible,coordinated,andfamily-centeredway.Establishmentofadentalhomebeginsnolaterthan12monthsofageandincludesreferraltodentalspecialistswhenappropriate.5
Dental Hygienist –Dentalhygienistsremovesoftandharddepositsfromteeth,teachpatientshowtoperformgoodoralhygiene,andprovideotherpreventivedentalcare.Theyexaminepatients’teethandgums,recordingthepresenceofdiseasesorabnormalities.DentalHygienistsaregraduatesofaccrediteddentalhygieneprogramsincollegesanduniversitiesandmustpassawrittennationalboardandclinicalboardtoobtainlicensureineachstate.7
Exam–Athoroughevaluationoftheteethandsoftstructuresinthemouth(suchasgums,cheeks,andtongue).Usedtoexaminetheteethforsignsoftoothdecay.Typicallyincludesx-raystohelpdiagnosetoothdecayorotherdentalrelatedissue.Maybeperformedbyadentist.Maybeperformedbyadentalhygienist,ifadentistispresentandmakesthefinaldiagnosisandconfirmationofthetreatmentthatisneeded.Maynotbeperformedbyadentalassistant.1,6
Fluoride–Substancethatmaybeappliedtotheteethinaprofessionalstrengthintheformofgel,varnish,foam,orliquid.
6
Gingiva–Gums
Gingivitis–Inflammationofthegums
Informed Consent-Informedconsentistheprocessofprovidingthepatientor,inthecaseofaminororincompetentadult,thecustodialparentorlegalguardianwithrelevantinformationregardingdiagnosisandtreatmentneedssothataneducateddecisionregardingtreatmentcanbemadebythepatientorcustodialparent/legalguardian.5
Mobile Dental Facility-Anyself-containedfacilityinwhichdentistrywillbepracticedwhichmaybemoved,towed,ortransportedfromonelocationtoanother.1
Pediatric Dentist–Adentalspecialist,whosepracticeislimitedtotreatmentofchildrenfrombirththroughadolescence,providingcomprehensiveoralhealthcare.6
Plaque–Soft,stickysubstancethataccumulatesonteethcomposedmostlyofbacteria.6
Prophylaxis–Aprofessionalcleaningoftheteeth,removingplaqueandhardenedbacteriaknownascalculus(tartar).6
Pulpotomy–Arootcanalprocureonaprimary(baby)tooth.
Radiographs–X-rays
Portable Dental Unit–Anynon-facilityinwhichdentalequipment,utilizedinthepracticeofdentistry,istransportedtoandutilizedonatemporarybasisatanout-of-officelocationincluding,butnotlimitedto,patients’homes,schools,nursinghomes,orotherinstitutions.6
School Health Clinic–Aschoolbasedhealthclinicthatprovidesdifferenttypesofhealthservicestothechildrenwithintheschool.
Screening-Aquicklookinsidethemouthtodetectobvioussignsoftoothdecay.Itiscustomarilyafreeserviceandnotaprocedurethatischargedtothepatient.
References1 TexasStateBoardofDentalExaminers2HealthInsurancePortabilityandAccountabilityActof19963TexasMedicaidandHealthCarePartnership4TexasEducationAgency5AmerianAcademyofPediatricDentistry6AmericanDentalAssociation,Current Dental Terminology,2009-20107UnitedStatesDepartmentofLabor,BureauofLaborStatistics
7
DaleEdmiaston,LMFT,LCSW,LCDC,Director,FamilyandCommunityResources,FortWorthISD
TonyaFuqua,DDS,SaveaSmileManager,CookChildren’sBeckiHale,RDH,MA,Children’sOralHealthCoalitionCoordinator,CookChildren’sAprilHarris,ExecutiveDirectorofDentalHealthArlingtonGinnyHickman,LMSW-AP,AVP,CommunityHealthOutreach,CookChildren’sJackMorrow,DDS,PediatricDentist,ChairoftheChildren’sOralHealthCoalition
CindyO’Neal,RDH,MS,TarrantCountyCollegeDentalHygieneProgramDirectorCindyParsons,BSN,RN,SchoolNurseAdministrator,KellerISDKashaPerkins,InterimExecutiveDirector,MasonicChildren&FamilyServicesofTexasAliceTurner-Jackson,RN,BSN,MS,SchoolNurseAdministrator,FortWorth,ISDAmandaStallings,ExecutiveDirector,GillChildren’sServicesMaureenWeber,DDS,DepartmentofStateHealthServices
MissionToimprovetheoralhealthofchildreninTarrantCountythroughcommunitycollaboration.
VisionAllchildreninTarrantCounty,withafocusonchildrenagesbirththroughthirdgrade,willreceivepreventivedentaleducationandpreventivetreatment,emphasizinggoodoralhygiene.ChildreninTitle1schoolswithseveredentalproblemswillreceivedentalcareandcomprehensivepreventivedentaleducation.
Who we areTheChildren’sOralHealthCoalition(COHC),ledbyCookChildren’sCommunityHealthOutreachDepartment,seekstoimprovetheoralhealthofchildreninTarrantCountywithakeyfocusonunderservedchildren.Thecoali-tionisadiverse,county-widecollaborationmadeupofmorethan30organizationsandmeetsbi-monthly.TheCOHCfollowsastrate-gicplantoguidetheirworkinthecommunity.Thisplanhasbeenupdatedfivetimessince1999.TheCOHChastwosubcommitteestocarryouttheworkofthestrategicplan:
• TheCommunityAwarenessSubcommittee• TheLegislativeAdvocacySubcommittee
AbramDentalAetnaBetterHealthAllSmilesDentalCenterTheAllianceoftheFortWorth
DistrictDentalSocietyArlingtonISDChildCareAssociatesCityofFortWorthCommunitiesinSchoolsCookChildren’sHealthCare
SystemCookChildren’sHealthPlanCookChildren’sMedical
CenterCookChildren’sPhysician
NetworkCrowleyISDDentalHealthArlingtonEarlyHeadStartECIofNorthCentralTexasFortWorthDistrictDental
SocietyFortWorthISDGillChildren’sServices,Inc.
GreaterFortWorthDentalHygienists’Society
JPSHealthNetworkMasonicChildrenandFamily
ServicesofTexasMaximus,Inc.(TexasHealth
Steps)MissionArlington/Mission
Metroplex/AllanSaxeDentalClinic
RodeoDental&OrthodonticsSouthTexasDentalTarrantCountyCollegeDental
HygieneProgramTarrantCountyPublicHealth
DepartmentTexasWoman’sUniversity
DentalHygienceProgramUnitedCommunityCenters,
Inc.UnitedWayofTarrantCountyYMCASoutheastConsultingOrganizations/
Individuals:LocalDentistsResourceAgency:Department
ofStateHealthServices
Ad hoc committee members:
Children’s Oral Health Coalition Children’s Oral Health Coalition members:
*MembershipdoesnotconstituteendorsementbytheChildren’sOralHealthCoalitionorCookChildren’s.