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CSPD Provides School Absence Information and Assistance
Dentists, and pediatric dentists in particular, are often challenged by parents anxious to avoid school absence, even when that absence is for the purpose of health care delivery. Although most practitioners establish scheduling policies and protocols intended to minimize pupil absence in a manner consistent with the patient’s age, the nature of the service provided, and fairness to all families in the practice, many are still confronted with school policies that seem or profess to prohibit absence from school for the delivery of dental care during school hours. As pediatric dentists, we recognize the importance of regular school attendance and the effect on education of chronic absence. We also recognize the negative financial implications to the school from the state when daily attendance is reduced. For these reasons, we have long urged our members to work with parents and with schools to minimize attendance disruption for oral health services ----- and better oral health through regular preventive care visits is one strategy for accomplishing this goal. It is not realistic, however, to expect that all pediatric and adolescent oral health care services can be delivered outside of school hours. In fact, state law [California Education Code §48205(a)(3)] specifically provides that "a pupil shall be excused from school when the absence is for the purpose of having medical, dental, optometrical, or chiropractic services rendered." In an effort to provide clarity on this issue to dentists, parents, and school educators, the California Society of Pediatric Dentistry has joined with the California Dental Association to provide a downloadable Message to Parents and School Administrators Regarding School Absence for Dental Appointments. This one-page information sheet, which contains Oral Health Facts for Children, may be downloaded from the CSPD and CDA websites for printing and distribution by dentists and their staffs. In addition, CSPD has developed a template for a School Attendance Release Form which may be downloaded from the CSPD website and customized by members for individual office printing and distribution (This is a MS Word doc file). The form contains reference to §48205(a)(3) of the Education Code. Mobile/Portable Dental Care Provider GuidelinesIn an effort to assist school districts approached by mobile/portable dental care providers, a statewide group of dental and education professionals, led by the California Dental Association and the Dental Health Foundation have developed a series of documents intended to give school decision-makers some tools and ideas to help make the best choice for a particular situation. Return to Top
California Legislature 2009-10
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| AB 684 (Ma) | Dental Claim Payment: Late Payment Penalties - This bill would set certain timeframes for acknowledgement of receipt a claim by dental insurers, specify information required on a notice to the claimant when a claim is contested or incomplete, and set a 30-day working period for payment of an uncontested claim. |
| CSPD Position: | Support |
| Outcome: | Bill Withdrawn |
| Comment: | As introduced, this bill would have increased the interest penalties for uncontested dental claims not paid within 60 days of receipt. As amended in the Senate 6/3/10, these provisions were removed. |
| AB 1524 (Hayashi) | Dental Licensure by Hybrid Portfolio Pathway - This bill would replace the clinical dental licensure examination administered by the Dental Board of California with an assessment process during enrollment at an in-state dental school. The Hybrid Portfolio Pathway (HPP) would utilize uniform standards of minimal clinical experiences and require a final assessment of the submitted portfolio at the end of the school program. |
| CSPD Position: | Watch |
| Comment: | Other current paths to dental licensure (with the exception of the California clinical examination) would remain available, including passage of the Western Regional Examination (WREB). The bill was amended 6/29/10 to require adoption of regulations by the Dental Board of California before implementation is permitted. Present proposed regulations do not require treatment of the primary dentition or treatment of the minor dental patient in the portfolio of cases that must be presented and are excluded from the competencies by which the applicant would be evaluated. |
| AB 1783 (Hayashi) | Denti-Cal: Change of Location Form - This bill would allow a dentist enrolled as a Denti-Cal provider changing practice location within the same county to continue enrollment by the filing of a change of address form with the Department of Health Care Services. |
| CSPD Position: | Support - Read CSPD's Letter of Support |
| Comment: | Existing law requires a dentist to file a new enrollment application for a change of address, a process that can take the better part of a year for approval. This change would allow uninterrupted practice, continuum of care to Dent-Cal patients, and conform to a similar provision already in place for physicians. |
| AB 2035 (Coto) | Self-Funded Dental Plans: Disclosure of ERISA Information - This bill would require that in the case of an adverse benefit determination claimants of a self-funded dental plan be informed of their right to appeal the determination, the process for filing an appeal, and that the plan is subject to compliance with the federal Employee Retirement Income Security Act (ERISA) and not subject to state law governing health care coverage for dental plans. |
| CSPD Position: | Support |
| Outcome: | Died in Committee |
| Comment: | This bill is identical to AB 745 (Coto), introduced in the last legislative session, which was vetoed by the Governor as "unnecessary". It enjoyed broad support in both houses of the legislature. Like AB 745, AB 2035 is sponsored by CDA. |
| AB 2699 (Bass) | Healing Arts: Licensure Exemption - Creates a state licensure exemption for out-of state licensed health care practitioners, including dentists, who provide free services on a short term, voluntary basis at events sponsored by not-for-profit community-based organizations. Requires the sponsoring organization to register the event with the applicable healing arts boards and bureaus of the Department of Consumer Affairs. |
| CSPD Position: | Neutral |
| Comment: | As originally written, this bill would have allowed licensure exemption if the sponsoring entity registered with a "local governmental agency," thereby circumventing the jurisdiction of the state licensing boards and bureaus. As amended 5/12/10, the sponsoring entity must now register and gain approval of the state licensing board having jurisdiction over the provider. |
| Past CA Dental Board Reports |
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August 2006
November 2006 February 2007 August 2007 November 2007 January 2008 March 2008 May 2008 August 2008 April 2009 July 2009 November 2009 February 2010 May 2010 |
The Dental Board of California met May 5-6, 2010, in South San Francisco. The following summarizes actions and issues coming before the Board pertinent to pediatric oral health
Return to TopRegistered Dental Assistant Written Examination Statistics
Last July 1, with the dissolution of the Committee on Dental Auxiliaries (COMDA), responsibility for the licensing of Registered Dental Assistants (RDA) passed to the Dental Board of California. Dental Board members in November expressed concern that the 2009 pass rate for the RDA written examination barely exceeded 50%. Utilizing a new written examination this year, the pass rate through April 23 was still only 52%, although the number of applicants taking the new written test as yet is too small for meaningful comparison. The Board directed staff to compile statistical information on the educational backgrounds and previous examination history of those taking the examination and will revisit the issue at its July meeting.Comment: The low pass rate for the written examination discourages interest in registered dental assisting as a career choice and limits the number of those entering the field. Pediatric dentists and those general practitioners treating significant numbers of children are particularly affected. Presently, there are approximately 35,000 active RDAs to serve the needs of California's approximately 37,000 actively licensed dentists.
Retroactive Fingerprinting Regulations
Currently the Dental Board of California along with other boards and bureaus of the Department of Consumer Affairs requires applicants for licensure to provide electronic fingerprint records for a criminal background check prior to issuance of the license. Although required since1999, this licensure prerequisite was not until now retroactive. Licensees who obtained their licenses prior to 1999 have no electronic fingerprint records on file with the Department of Justice. As a result the Board has no access to the criminal history or automatic reporting of arrest records of any dentist or registered dental assistant category licensed prior to 1999.To remedy this situation, the Board approved regulatory language in February to require the submission of electronic fingerprint records to the Department of Justice as a condition of license renewal for any licensee without such records on file. The licensee will pay the costs of furnishing the fingerprints and the Department of Justice search, estimated at $50 to $60. As another condition of license renewal, the licensee will be required to self-disclose whether, in the prior renewal cycle, he or she has been convicted of any violation of law in California or any other state or country, omitting traffic infractions under $1,000.00, so long as the infraction does not involve alcohol, dangerous drugs, or controlled substances.
Comment: To facilitate compliance with the new requirement, CDA anticipates offering electronic fingerprinting and registration with the Department of Justice at their statewide meetings, beginning in San Francisco in the fall of this year. Dentists and registered dental assistants will be able to access DBC records to determine if they must comply with this requirement on their next licensure renewal, and if so, meet the requirement on the spot.
The California Society of Pediatric Dentistry in collaboration with the California Dental Association has produced an advocacy binder dramatically illustrating The Consequences of Untreated Dental Disease in Children.
Designed for supporting CDA and CSPD efforts in promoting legislation and public policy which improve children’s oral health, the binder contains introductory information on the progressive and largely preventable nature of dental disease, full color illustrations of untreated pediatric dental conditions, and a Children’s Oral Health Fact Sheet
The binder is available for viewing and for downloading by CSPD members. (PDF Document, 1.2 MB)
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Groundbreaking legislation effective January 1, 2007 requires children entering public school for the first time in either kindergarten or first grade to present proof by May 31 of the school year of having obtained an oral health assessment. That assessment may be completed during the first year of school or any time in the 12 months prior to school enrollment.
CSPD, working with the California Dental Association, has long sought such regulation as a means of identifying children in need of oral health services and promoting the importance of oral health as an integral component of school readiness and ability to learn.
Dentists should be aware of the following provisions of the bill:
It is important for dentists to understand the difference between a dental examination, which can be performed only by a licensed dentist, and an oral health assessment, which can be performed by a range of licensed dental professionals. An oral health assessment identifies obvious or suspected oral health conditions that require, or might require, examination by a dentist. A dental examination diagnoses dental conditions and forms the basis for treatment recommendations.
A dental examination conducted in a dental office during the first school year or in the 12 months prior to school enrollment more than meets the minimum standards of the assessment requirement.
The goal of this legislation is to establish a regular source of dental care (a dental home) for every child. The program will also identify children in need of further examination and dental treatment and will help in the identification of barriers to the delivery of dental care.
For additional information all located on this page, please use the appropriate links:
Questions concerning California Oral Health Assessments may be directed to CSPD Public Policy Advocate, Dr. Paul Reggiardo, at Reggiardo@prodigy.net or by phone at 714-848-0234.
Return to TopWhat Does the Law Require?
What is an Oral Health Assessment?
The assessment, or evaluation, can be met in many ways. It can be a complete examination and treatment plan performed by a dentist, or it can be a more basic oral health evaluation, such as a screening, which can be performed by a dentist, hygienist or a registered dental assistant with supervision.
How should an office respond when a parent calls requesting the required "oral health assessment" for their child?
If the child is already a patient of record, it should be a routine matter to schedule a dental examination for the child. The oral health assessment requirement is not intended to alter your usual office protocol with regard to new or recall examinations. The only "new" part of the visit is completion of the required "assessment form." The form is simply a data collection tool and requires information on the following four items:
How should an office respond when the parent of a new patient calls making the same request?
As with all new patients, the child ideally should receive a comprehensive examination. In some instances, however, it may be a multi-step process before a child receives the desired exam. It is therefore important to develop a protocol when the parent questions the need to make an appointment for an examination, citing the request for "just an assessment."
Many factors may contribute to the parent's decision to schedule the recommended examination, including available insurance coverage, the parents' understanding of the difference between an assessment and an examination, and the parents' expectation that an assessment, or basic screening, is all the child needs. An office protocol should include a clear explanation of the differences between a basic screening and a comprehensive examination, so that the parent can make an informed decision.
If, after explaining the value of a comprehensive dental examination, the caller still requests only a screening assessment to meet the basic requirements of law, how might the office proceed?
When a dental examination is not feasible, the child will still benefit from the simple assessment intended to identify obvious unmet oral health needs and to provide a data collection tool for state-wide oral health planning. Therefore, CSPD encourages members to consider offering to screen the child and complete the mandated assessment form in the office without charge.
Under legislation long sought by CSPD and effective January 1 of this year, children enrolled in their first year of public school in either kindergarten or first grade are now required to obtain an assessment of their oral health as part of school readiness preparation. For children who already see a dentist and have established a dental home, compliance will be as simple as calling the office and requesting that the dentist fill-out and return the data collection form sent home by the school. Any dental examination conducted in the 12 months prior to the beginning of the school year will meet the assessment requirement, although dentists may wish to recommend a more recent examination when indicated in the best interests of the child. Parents have until May 31st to return the State’s data collection form to the school. While many schools districts are placing school information at the top of the form, dentists and parents may download and use the form available from the California Department of Education. A link to the California Department of Education website and a direct link to downloadable English and Spanish versions of the form are now available on the CSPD website (www.cspd).
For children who have not received a dental examination in the twelve months prior to school entrance, parents have several options. They may schedule a dental examination with a licensed dentist, they may arrange an oral assessment or screening evaluation by any licensed dental professional (a dentist, dental hygienist, or registered dental assistant under the direct supervision of the dentist), or they may request a waiver of the requirement. CSPD members have the opportunity to play a critical role in which decision is made by the parent.
The best decision for the child, and a significant intent of the legislation, is the establishment of a dental home through the scheduling of a comprehensive dental examination. When this is not possible or feasible, CSPD urges its members to consider providing a screening assessment in their office as a public service. It is important for both dentists and parents to understand the difference between a dental examination, which is a billable service and establishes the dental home, and a screening assessment which is not considered a billable service and only (1) collects the data required by the state concerning the incidence of treated and untreated dental caries and (2) identifies obvious or suspected conditions which require, or might require, examination and treatment by a dentist.
If a screening evaluation is conducted in the dental office it does not establish a dentist-patient relationship. Patients receiving such assessments do not become a patient-of-record and should not be expected to complete health histories or other office forms. To assist members providing these assessments, CSPD and CDA have developed a Consent and Recommendation Form for use in the dental office. The form provides for the consent of the parent or caregiver, explains the limitations and differences between an oral assessment and a comprehensive oral/dental examination, and provides a section in which the dentist can make recommendations concerning the child’s oral health. The form, in multiple languages, is downloadable from the CSPD website (www.cspd). It should be given to the parent or caregiver, along with the State data collection form, and a copy kept in the office for a period of one year. Oral evaluations performed in the dental office help parents meet the school requirement and serve as an introduction to the dental delivery system.
CSPD anticipates may school districts, especially those most impacted by oral health disparities, will work with local dentists and local component dental societies to establish school-based and school-linked oral health screenings to ensure pupils receive these assessments. Such screenings will provide an additional opportunity to create effective systems of triage and referral of children whose families experience barriers to dental care and the establishment of a dental home. CSPD encourages the participation of its members in these activities as well as in providing in-office assessments.
Ultimately, the success and survival of school-entrance oral health examinations and assessments will be judged by public compliance with the legislation. Parents may receive a waiver of the requirement by indicating the assessment poses an undue financial burden, cannot be completed because they are unable to locate a dental professional to perform the assessment, or by simply withholding consent. By facilitating the examination and assessment process, CSPD members make it less likely a parent will choose to use the waiver.
Paul Reggiardo, DDS
Public Policy Advocate
California Society of Pediatric Dentistry
February, 2007
| CSPD/CDA Developed In-Office Consent for Assessment and Recommendations |
State Required Oral Health Assessment-Waiver Forms |
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The state-required oral assessment form to be returned to the school is a simple data collection tool that requires the following four pieces of information.
The California Society of Pediatric Dentistry joins with other state health care and patient advocacy organizations in opposing elimination of adult dental services under the state Medi-Cal program. Oral health is integral to general health and not an optional health service. Eliminating adult dental care will have a profound adverse effect on low-income adults, will immediately increase the cost of emergency medical services delivered in hospitals and physician's offices, and will ultimately result in greater future obligations to the state's general fund as oral conditions worsen without appropriate care. Children served by Medi-Cal will be affected as well:
Members interested in CSPD's public policy stance may view the letters sent to Senate President proTem Darrell Steinberg and Speaker of the Assembly Karen Bass during state budget negotiations.
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On March 1 of this year, the California Department of Health Care Services (DHCS) implemented mandatory CDT-4 coding for all treatment authorization requests and claims submissions. CSPD member Jose Polido of Children's Hospital Los Angeles contacted CSPD recently to ask why CDT code D0140, defined by the ADA as a Limited Oral Evaluation -- Problem Focused, for situations of "emergency and trauma," is routinely denied by Denti-Cal when used for this purpose.
As indicated in the Medi-Cal Dental Program Provider Handbook (March 2008), Denti-Cal uses D0140 not for the broad range of problem-focused cases as specified by the ADA code, but instead, for payment of an initial orthodontic evaluation by a Medi-Cal Dental Program certified orthodontist.
According to a representative of the Department of Health Care Services, because orthodontic services are not generally a benefit of the Denti-Cal program, unless required by the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) medical necessity provisions of the Medicaid act (such as in the delivery of care for cleft lip and palate), the Department needed a CDT-4 diagnostic code for assessing such qualification. They choose D0140.
When asked, therefore, what code was appropriate and payable when a limited oral evaluation of emergency or trauma was provided [and other evaluation codes such as that for comprehensive oral evaluation (D0150) or periodic oral evaluation (D0120) were either inappropriate or unavailable], the DHCS representative suggested that for "problem focused" evaluations, providers should use D9430, which is defined in the Handbook as a catch-all, general "observation" code during regularly scheduled office hours in which no other services are performed (other than necessary radiographs and/or photographs).
Members should be aware, however, that Denti-Cal billing for D9430 requires "written documentation for payment" that "shall include the tooth/area, the chief complaint and the non-clinical treatment taken."
If, under the above DHCS guidelines, members experience claim denials, they are requested to contact CSPD's Public Policy Advocate, Paul Reggiardo, at 714-848-0234 or at Reggiardo@prodigy.net with the detail.
Return to TopWhen is coronal polishing considered an oral prophylaxis? The answer, of course, under the California Dental Practice Act, is never.
Section 1086 of the California Code of Regulations permits a Registered Dental Assistant to perform coronal polishing subject to certain conditions. One of these conditions is that the procedure must be performed under the direct supervision of a licensed dentist and only pursuant to the order, control and full professional responsibility of that supervising dentist. Under the provisions of direct supervision, the procedure must be checked and approved by the dentist prior to dismissal of the patient from the office. The Act states that "this procedure shall not be intended or interpreted as a complete oral prophylaxis (a procedure which can be performed only by a licensed dentist or registered dental hygienist)" and that the licensed dentist or a registered dental hygienist "shall determine that the teeth to be polished are free of calculus or other extraneous material prior to coronal polishing."
Section 1067 defines coronal polishing as a "procedure limited to the removal of plaque and stain from exposed tooth surfaces, utilizing an appropriate rotary instrument with rubber cup or brush and a polishing agent."
An oral prophylaxis is defined in the same section as "preventive dental procedures including complete removal of explorer-detectable calculus, soft deposits, plaque, stains, and the smoothing of unattached tooth surfaces. The objective of this treatment shall be creation of an environment in which hard and soft tissues can be maintained in good health by the patient."
Only a currently-licensed Registered Dental Assistant (RDA) may perform coronal polishing, which is considered part of an oral prophylaxis. Since January 1, 2006, all Registered Dental Assistants have been required to have completed an approved course in coronal polishing to obtain or renew their licenses.
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The California Society of Pediatric Dentistry is the state's leading advocate for the optimal oral health of infants, children, and adolescents, including those with special needs. The Society serves its members and represents the specialty of Pediatric Dentistry in California to achieve excellence in practice, education, and research.