Regulations, Laws and Guidelines Affecting Louisiana Dental Practices

Revised Statute 40:1236.14: In addition to the civil immunity provided to persons rendering emergency assistance as provided by law, including R.S. 9:2793, R.S. 37:1731, 1732, and 1735, and R.S. 40:1231.2, any prescribing advanced practice registered nurse or physician who authorizes the purchase of the AED, any physician or advanced practice registered nurse involved in the possessor's program, any individual or entity which provides training in cardiopulmonary resuscitation and in the use of an AED, any purchaser of an AED, any person or entity who owns or who is responsible for the site or the private security patrol vehicle where an AED is located, and any expected user regularly on the premises or in the vehicle shall not be liable for any civil damages arising from any act or omission of acts related to the operation of or failure to operate an AED that do not amount to willful or wanton misconduct or gross negligence.

Note: The degree of protection for providers actually afforded by this law has never been specifically tested in court.

The Food and Drug Administration encourages all health care providers to report serious, adverse reactions and product defects associated with medications, devices and nutritional products to their department through their MEDWATCH reporting system. Submit a voluntary report on Form #3500, or report by phone, fax or Internet via the numbers and web address below. The FDA also publishes a guide for health care providers, The FDA Desk Guide for Adverse Events and Product Problems. For more information, contact the FDA at: 800-FDA-1088, 800-FDA-0178 (FAX) or www.fda.gov/medwatch.  

Laws regulating advertising are a part of the Louisiana State Dental Practice Act. Refer to Louisiana Revised Statutes 37:774–776 and Rule 301 of the Rules and Regulations of the Louisiana State Board of Dentistry (LSBD). All the rules and regulations as well as the Laws of the State of Louisiana Governing the Practice of Dentistry—commonly known as the Dental Practice Act—are included in a booklet published by the LSBD. Licensed dentists receive the booklet along with their license renewal. For additional copies, contact: Louisiana State Board of Dentistry, One Canal Place, Suite 2680, 365 Canal Street, New Orleans, LA 70130, 504-568-8574, www.lsbd.org. 

This federal law protects disabled persons from discrimination in employment, hiring, transportation, access to public facilities and services and telecommunications. Title III of the ADA prohibits discrimination against hearing-impaired individuals in public places, including dental offices. Health care providers can be required to furnish interpreters for hearing impaired patients at no cost to the patient, if doing so is necessary to achieve equal and effective communication.

The law also prohibits discrimination in services, including dental care, to persons with physical or mental disabilities, which many courts have held to include HIV infection. Under the ADA, a person with a physical or mental impairment that substantially limits a major life activity is considered disabled, as well as a person wit a record of having such impairment and a person who is regarded as having such impairment.

The Americans with Disabilities Act also requires that places of public accommodation, including physicians’ and dentists’ offices, be accessible to persons with disabilities. With the advent of the internet, and of websites that businesses utilize to provide additional access to the public, the U.S. Department of Justice has taken the position that websites open to the public must also be accessible in various ways to persons with sight or hearing impairment. This interpretation may affect not only the websites of our members.

White Paper from the ADA on Website Accessibility
Alt Tags Sample
Video Captioning Sample

For more information on dentists’ obligations under the Act, call: U.S. Justice Department Information Line, 800-514-0301, ADA Technical Assistance, 800-949-4ADA, www.adata.org.

In 1997, the American Heart Association issued new guidelines for dentists and physicians treating patients at risk for bacterial endocarditis. The key points include:

•  In most cases, endocarditis is not attributable to invasive procedures.
• Cardiac conditions are stratified into risk categories based on potential outcome if endocarditis develops.
• Procedures that cause bacteremia and for which prophylaxis is recommended are more clearly specified.
• An algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse.
• For oral/dental procedures, the initial amoxicillin dose is reduced to 2g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered.

A complete summary of the guidelines is available in the August 1997 issue of JAMA. A copy of the American Heart Association’s complete recommendations is available by phone or online at: 800-242-8721 or www.americanheart.org.

Women of childbearing age should be aware of possible reduced efficiency of oral contraceptives during antibiotic therapy. They should be advised to use additional contraceptives during the antibiotic usage and to consult their physicians about the possibility of higher doses of oral contraceptives. The patient should sign a form attesting to her knowledge of this situation, and the form should be kept in the patient’s treatment record.

Dentists should be aware of the civil and criminal implications of collective negotiation and other group activity, particularly in the context of dealing with managed care plans. For general information or assistance with specific issues related to antitrust laws, contact the ADA Department of Legal Affairs at 800-621-8099.

ADA Antitrust Laws in Dentistry

La. R.S. 22:1154.B(1)(b) states that no state-regulated dental plan can deny a dentist the right to participate.

La. R.S. 22:1878 (exception to balance billing prohibition) states that, if a dental plan covers a particular treatment for a dental condition and a patient chooses an alternate (i.e., more expensive) treatment, the plan may pay for the usual treatment and the dentist may bill the patient for the difference IF the patient agrees in advance and in writing.

According to the American Dental Association’s Principles of Ethics and Code of Professional Conduct, it is unethical for dentists to practice while abusing controlled substances, alcohol or other chemical agents which impair their ability to practice dentistry. Additionally, if a dentist has firsthand knowledge that a colleague is practicing dentistry while so impaired, he/she has an ethical responsibility to report evidence to the dental association’s professional assistance committee. The LDA has established the Dentists’ Well-Being Advisory Committee to help the dentist, his/her family or other concerned parties into treatment for chemical dependency. This committee is bound to handle all inquiries in strict confidence.  Contact the LDA at 800-388-6642 or 225-926-1986 or e-mail: info@ladental.org.

According to Louisiana Revised Statute 14:402-403.4, a “mandatory reporter” of child abuse includes any individual who provides health care service. This includes dentists and their staffs. Any “mandatory reporter” who has cause to believe that a child’s physical or mental health is endangered due to abuse or neglect shall report to either the local child protection unit or to the local or state law enforcement agency. Any person who makes a report in good faith and cooperates in any investigation is immune from civil or criminal liability, except when the reporter is an alleged principal, conspirator or accessory to any abuse, or the report is knowingly false or submitted with reckless disregard for the truth. The Louisiana Children's Code, Article 609, A.(2) states the following: "Violation of the duties imposed upon a mandatory reporter subjects the offender to criminal prosecution authorized by R.S. 14:403(A)(1)."

La. R.S. 22:1155 states that ONLY a U.S.-licensed dentist can deny a dental claim for medical necessity reasons, and ONLY a U.S.-licensed dentist who is NOT an employee of the insurer can make a subsequent denial if the initial denial is appealed. Plus, any communication about the denial on appeal must include licensing and contact information for the dentist issuing the denial.

Louisiana law requires certain insurance policies to provide coverage and certain benefits for the medical condition of cleft lip and cleft palate. Title 22 of the Louisiana Revised Statues, §215.8 requires any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, and a self-insurance plan that provides medical and surgical benefits which is delivered, issued for delivery or renewed in this state on or after January 1, 1998, shall include coverage for the treatment and correction of cleft lip and cleft palate.  Such coverage shall also include benefits for secondary conditions and treatment attributable to that primary medical condition.  

For more information on the benefits included with cleft lip or cleft palate insurance coverage, contact the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org.

The ADA developed a brochure titled "Closing A Dental Practice: A Guide for the Retiring Dentist or Surviving Spouse." Download this brochure for information on managing patient records, dismissing staff, disposing of equipment and supplies and necessary notifications. The information also contains sample letters and tips on ways to close a dental practice at retirement or in the event of a dentist's long-term illness or death. More information can be found by clicking here.

According to Louisiana Revised Statutes 9:3563-3567, any person engaged in consumer credit sales or consumer loans or person who takes assignments of and undertakes direct collection of payments from or enforcement of rights against debtors arising from these sales or loans shall file notification with the Commissioner of Financial Institutions within 30 days after commencing business within the state, and no later than April 1 of each calendar year thereafter. An entity with consumer credit sales of $500,000 or less in the preceding year must remit a $75 fee with the notification. If the notification and fee have not been received by April 15, the entity is subject to a $50 late fee; thereafter, an entity is subject to forfeiture of credit privileges if the notification, fee, and late fee are not received by May 30. Notification and fee filing are not required by Louisiana licensed lenders or by any person whose only act of extending credit is the making of a sale to a consumer by honoring a credit card issued by a supervised financial organization, where such seller receives payment for the sale from the credit card issuer and retains neither interest in the extension of credit, nor a right of recourse against the buyer in the event of non-payment of the account. For more information, call: Office of Financial Institutions, Consumer Credit Division, P.O. Box 94095, Baton Rouge, LA 70804-9095 or 225-925-4660.

Free to ADA/LDA members is the ADA's Contract Analysis Service, which can help educate dentists concerning the potential risks and benefits of contractual relationships with third parties (e.g., managed care companies and dental management service organizations). To participate, contact the LDA office at info@ladental.org.

The ADA offers a Dental Benefit Video Series that is very helpful for members. It is accessible ONLY to ADA members. ADA members can access the videos at http://success.ada.org/en/dental-benefits/dental-benefit-videos.

Louisiana law prohibits discrimination against dental care services under specific circumstances. Louisiana Revised Statute 22:213.1 provides that payment for health care services shall not be denied under a policy, contract or other document providing for the payment of health care treatment procedures if the services are rendered by a licensed dentist if the following two conditions are met:

1. The health care services would be covered if provided by a person licensed to engage in the practice of medicine and surgery.
2. The health care services can be lawfully performed within the scope of practice of a licensed dentist.

For more information on the Dental Fairness Act, contact the LDA at 800-388-6642, 225-926-1986 or email info@ladental.org.

The Centers for Disease Control recommends that dental instruments that can withstand high temperatures should be sterilized: (1) in a steam autoclave, (2) with dry heat in an oven-like environment, or (3) using chemical vapor. All others should be scrubbed clean and sterilized/disinfected in chemical solutions. Use disinfection procedures on surfaces and equipment that cannot be removed for sterilization. They include counter tops, drawer handles, x-ray unit heads and light handles. The CDC publication Recommended Infection-Control Practices for Dentistry is included in the booklet published by the Louisiana State Board of Dentistry and may be downloaded via: Division of Oral Health, Centers for Disease Control, 770-488-6055 or www.cdc.gov.

Louisiana Revised Statutes 22:1511 states that “No person shall act as or hold himself out to be a dental service contractor in this state, unless that person has qualified and has been issued a certificate of authority as a domestic insurer or has been admitted to transact business in this state and issued a certificate of insurance as a foreign or alien insurer under this Title... Every dental service contractor operating in this state shall be regulated by the commissioner as a domestic or foreign health and accident insurer and shall meet all of the requirements established by this Title applicable to health and accident insurers, including all capital, surplus and deposit requirements. For purposes of regulation, a contract between a dental service contractor and a subscriber shall be considered a health and accident insurance policy, and the subscriber shall be considered a policyholder...”

These basic guidelines should be considered when terminating dentist-patient relationships:

1. Dental treatment in progress must either be completed so the patient’s health will not be jeopardized or the patient should be referred to another qualified dentist or specialist;
2. Before terminating a dentist-patient relationship, a dentist should seek advice from an attorney and/or malpractice insurance carrier;
3. To end this relationship, the dentist should send the patient a written notification via certified mail, return receipt requested. The notice to the patient should include the date the relationship will end (allowing reasonable notice), suggestions on how to find another dentist, an offer to forward the patient’s records to a new dentist, an offer to provide emergency care for a reasonable period of time, and a statement of the current status of care and future need for treatment; and
4. AIDS or HIV positive diagnoses are typically not valid reasons for termination.

For more information, visit https://success.ada.org/en/practice-management/guidelines-for-practice-success/managing-patients/dismissal for more information on business and practice management employment issues, including sample letters.

Louisiana's Downcoding Law (Act 187, passed during the 202 Legislative Session) prohibits a dental service contractor (third party payer) from systematically downcoding with the intent to deny reimbursement otherwise due to a dentist or other healthcare provider. It also prohibits downcoding the installation service of a fixed bridge to a removable bridge.

Additionally, if a procedure code change is made, the explanation of benefits (EOB) provided to the patient shall include the reason for the downcoding and citation of the dental service contractor's applicable policy. The EOB shall not state or infer that the code billed by the dentist or other healthcare provider was inappropriate unless there is clear evidence the code listed on the claim by the provider in no way related to the procedure performed. The EOB shall not state or infer that the healthcare provider's charge was excessive unless there is clear evidence the charge was substantially higher than the provider's regular fees. The third party payer shall disclose in its provider contracts, on its website, or both, the specific downcoding policies that the dental service contractor reasonably expects to be applied to the provider or provider's services on a routine basis as a matter of policy.

For a license to write prescriptions in Louisiana, contact the LA Department of Health (LDH), Controlled Dangerous Substances Section, P.O. Box 3767, Baton Rouge, LA 70802 or 225-342-9404.

After completing your application, return it along with a $20 check to the above address. You should also include a copy of your dental license which shows the date of expiration. You will then be assigned a Controlled Dangerous Substances (CDS) number. You should then request a copy of Form 224 (Form 224a for renewals) from the Federal Drug Enforcement Administration. Forms are available online at www.deadiversion.usdoj.gov.

Return the form to the DEA with the $390 registration fee. For more registration information, contact the DEA field office:
Registration Unit of the U. S. Department of Justice
Federal Drug Enforcement Administration
3838 North Causeway Blvd., Suite 1800
Three Lakeway Center
Metairie, LA 70002
504-840-1063 or 888-514-7302
For general information, call the DEA at 800-882-9539.

The American Recovery and Reinvestment Act of 2009 (Recovery Act) includes the Health Information Technology for Economic and Clinical Health Act, or the "HITECH Act," which established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of certified electronic health records (EHR) technology.

There is *no federal deadline* for adoption of Electronic Health Records (EHRs) by dentists who do not submit claims to Medicare. However, Medicare eligible professionals will have a payment adjustment in their Medicare reimbursement for failure to implement “meaningful use” of EHRs starting in 2015. Eligible professionals may begin participating in the Medicare EHR incentive program as early as 2011, and the program ends in 2016.

The Medicare and Medicaid program aspects of HITECH may not affect most dentists because many dentists do not provide Medicare-covered services or meet the Medicaid incentive program patient-volume threshold. However, dentists should not ignore other aspects of HITECH, especially those parts concerning Privacy, Security, and the Breach Notification Rule.

Louisiana has already started a Medicaid EHR Incentive Program in which eligible medical professionals and hospitals can receive incentive payments for adopting, implementing or upgrading certified EHR technology during their first year of participation, and can earn payments for up to five subsequent years for demonstrating meaningful use of EHR.

Louisiana Revised Statutes 37:1731 (D) provides that “No dentist licensed under the provisions of Chapter 9 of this title, who in good faith gratuitously renders emergency care or services at the scene of an emergency, except in a licensed dental office or public or private hospital, to a person or persons in need thereof, shall be liable for any civil damages as a result of any act or omission by such person in rendering the care or services or as a result or any act or failure to act to provide or arrange for further dental care or treatment or care for the person involved in the emergency.”

The Immigration Reform and Control Act of 1986 affects all employers, regardless of the number or national origin of persons employed. The IRCA requires all employers to complete an Employment Verification Form I-9 for every new employee hired after November 6, 1986. For these forms, contact the INS at: Immigration and Naturalization Services, 800-870-3676, http://www.uscis.gov/.

Employers must have federal and state tax identification numbers to report employee wages and to remit payroll taxes. For your Federal Employer Identification Number (EIN), call: Internal Revenue Service (IRS) at 800-829-1040 or www.irs.gov.

Information on a state employer identification number is available at: LA Department of Revenue and Taxation, 225-219-7318, www.rev.state.la.us.

For a complete listing of poster requirements, visit the Louisiana Workforce Commission at http://www.laworks.net/downloads/downloads_posters.asp.

State and federal laws require employers to display certain posters. Below is a list of state-required posters distributed by the Louisiana Department of Labor, available at any statewide Job Service Office:

1. Notice to Workers regarding Unemployment Insurance Benefits (LDET-ES 74)
2. Louisiana Minor Labor Law Placard (if employing anyone age 17 or younger)
3. Notice of Compliance to Employees
4.  Sickle Cell Anemia (If employing 15 or more people), Civil Rights Bureau, Department of Social Services, 225-342-2700
5. Smoking
6. Out-of-State Motor Vehicles
7. Fair Employment and Age Discrimination

The federal government requires the following posters:

1. Minimum Wage, WH Publication 1088 (required for all businesses subject to the Fair Labor Standards Act). Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting www.dol.gov.
2.  Employee Polygraph Protection Act. Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting www.dol.gov.
3. Job Safety and Health Protection, OSHA 2203. Obtain this poster from the Federal OSHA Office by calling 225-389-0474.
4. Family and Medical Leave Act, WH Publication 1420 (for employers with 50 or more employees). Obtain this poster from the U. S. Department of Labor, Wage and Hour Division, by calling 504-589-6171 or visiting www.dol.gov.
5. Equal Employment Opportunity (for employers with 20 or more employees). Obtain this poster from the EEOC office by calling 800-669-3362 or visiting www.dol.gov.
6. Genetic Information and Privacy. For more information on posters required by state and federal law, visit http://www.laworks.net/Downloads/Downloads_Posters.asp.

Act 89, passed during the 2021 Legislative Session, adds the review of dental insurance plans under the Health Insurance Issuer External Review Act. Louisiana passed the Health Insurance Issuer External Review Act in 2013, allowing individuals to file claims and appeals for an independent review related to their medical insurance in the event they disagree with the coverage decision. This act shall apply to external review or adverse determinations involving individual claims in excess of $250.

Many states who have this external review process also include dental insurance claims as eligible for this review process, but not Louisiana. In fact, Louisiana Medicaid coverage already allows for independent reviews on dental and medical claims. However, private insurance does not include dentists.

Louisiana Revised Statute 37:776 prohibits fee splitting, although it does not forbid licensed dentists from practicing in a partnership or professional corporation and sharing professional fees, nor does it forbid a licensed dentist from employing another licensed dentist. Any acceptance, sharing or division of dental fees by a dentist under suspension or revocation shall be sufficient cause for the State Board of Dentistry to withhold the reinstatement of his/ her dental license until the Board determines he/she has been fully rehabilitated. For more information, contact:
Louisiana State Board of Dentistry
One Canal Place, Suite 2680
365 Canal Street
New Orleans, LA 70130
504-568-8574
www.lsbd.org

Louisiana Revised Statutes 22:1154 states that “no health insurance policy or employee benefit plan delivered in the State of Louisiana shall prevent any person who is a party to or beneficiary of any such health insurance policy or employee benefit plan from selecting the dentist of his choice to furnish the dental care services offered by the policy or plan, or interfere with such selection.” However, the courts have held that ERISA, the federal statute governing self-insured employee benefit plans, preempts state “any-willing-provider laws.” For more information, download the Freedom of Choice: The Law is on Your Side fact sheet or visit the Louisiana Department of insurance Web site at https://www.ldi.la.gov/onlineservices/ConsumerComplaintForm to fill out the general complaint form.

Under Louisiana Revised Statute 22:228.7, health care plans issued, delivered or renewed in Louisiana after January 1, 1998, are required to provide benefits for anesthesia rendered in a hospital setting and for associated hospital charges when the mental or physical condition of the insured necessitates that dental treatment be rendered in a hospital setting. In determining whether performing dental procedures under general anesthesia is appropriate for a patient, dentists are required to consider as utilization standards the Indications for General Anesthesia as published in the reference manual of the American Academy of Pediatric Dentistry (AAPD). Coverage will not apply to treatments rendered for TMJ.

Insurers may apply the following restrictions:

• Coverage to include only procedures performed by dentists who have hospital privileges.
• Coverage to include only procedures performed by pediatric dentistry specialists or fully accredited specialists in a recognized dental specialty for which hospital privileges are granted.
• Prior authorization required in the same manner as for other covered medical conditions.

The LDA has prepared a packet of complete information about the law, including form letters that may be sent to insurers who do not appear to be complying fully with the law.  To obtain a packet, contact the LDA at 800-388-6642, 225-926-1986 or email info@ladental.org.

In accordance with Act 744 of the regular session of the Louisiana Legislature, effective June 29, 2006, dental hygienists may work under the general supervision of dentists licensed to practice in the state of Louisiana. Under general supervision, a dental hygienist may provide to patients of record, for not more than five consecutive business days, all dental hygiene services (except local anesthesia and root planning which must be under direct supervision) if all of the following rules are satisfied.

1. The enabling statute must be placed under La. R.S. 37:766.

La. R.S. 37:766 Hygienists, employment; operations limited

A. Any Louisiana licensed dentist of good standing, public institution, or school authority may employ a licensed hygienist who may perform such duties as may be authorized by the board. A registered dental hygienist may operate under a licensed Louisiana dentist’s direct or general supervision as those terms are defined in the Louisiana Administrative Code (Title 46 - Professional and Occupational Standards - Part XXXIII Dental Health Professionals-Rule 108). The licensed hygienist shall be responsible for providing notification to the board of the name and location of his employer.

2. The following rules have been suggested.

**B. Under general supervision, a dental hygienist may provide to patients of record, for not more than five (5) consecutive business days, all dental hygiene services (except local anesthesia and root planing which must be under direct supervision) if all of the following conditions are satisfied:

(1) The dental hygienist has at least three (3) years, or an equivalent amount of experience, in the practice of dental hygiene;

(2) The dental hygienist has current CPR certification and complies with the established protocols for emergencies which the supervising dentist has established;

(3) The supervising dentist has examined the patient of record not more than nine (9) months prior to the date that the dental hygienist provides the dental hygiene services;

(4) The dental hygienist provides dental hygiene services to the patient of record in accordance with a written treatment protocol prescribed by the supervising dentist for the patient;

(5) The patient of record is notified in advance of the appointment that the supervising dentist will be absent from the location;

(6) No licensed dental hygienist, under general supervision, may delegate or supervise any dental hygiene duties for an expanded duty dental assistant; and,

(7) The dentist is responsible for all actions of the dental hygienist during treatment of patients under general supervision.

B. The following limitations also apply to the practice of dental hygiene under general supervision:

(1) No entity other than a public institution or school supervised by a Louisiana licensed dentist, or an office owned by a dentist or group of dentists licensed in Louisiana, may employ dental hygienists to provide treatment for patients of record under general supervision.

(2) No duly licensed and registered dentist shall supervise more than two (2) dental hygienists under general supervision at any one time.

(3) No duly licensed and registered dentist shall supervise a dental hygienist for more than five (5) consecutive business days or for more than twenty total (20)* days in any calendar year.

(4) No patient can be seen twice consecutively under general supervision.

(5) An examination fee must not be charged if a patient is seen under general supervision.

(6) No person shall practice dental hygiene in a manner which is separate or independent from a supervising dentist, or establish or maintain an office or a practice that is primarily devoted to providing dental hygiene services.

Medical waste from health care facilities must be treated in a way that destroys its potential for causing disease, prior to disposing it in a landfill. Acceptable treatment methods may include incineration, steam sterilization (or autoclaving), and chemical disinfection. Waste that has been treated but is still recognizable as medical waste (for example, waste that has been autoclaved which is still in a red bag or sharps container) must be labeled with the name of the facility that generated it, the type of treatment method used, and the name or initials of the person in charge of treatment. Disposal of medical waste must be in accordance with all federal, state, and local regulations.

Except for small quantities, potentially infectious medical wastes can be transported off the site where they were generated only by transporters permitted by the State Health Officer. Small quantity generators, including dentists’ offices, may transport small quantities of properly packaged and labeled wastes to approved large quantity generators, permitted storage facilities, or permitted treatment facilities without meeting the requirements for transport and treatment that large quantity generators must meet. Transportation of potentially infectious waste (except by small quantity generators) is governed by Section 27:023 of the regulations.

To avoid violating federal regulations and facing severe penalties, call: Department of Environmental Quality, 225-765-0355, www.deq.state.la.us.

This federal law restricts the use of patient information and imposes standards for electronic transmission of health information. Dentists who utilize electronic transactions in their practices must comply with the provisions of HIPAA. Members may purchase a HIPAA Privacy Kit through the ADA by calling (800) 621-8099, and other HIPAA compliance tips can be found at http://www.ada.org/en/publications/ada-catalog/complete-hipaa-compliance-kit

The U.S. Department of Health and Human Services (HHS) protects the health of all Americans and provides essential human services, especially for those least able to help themselves. HHS Office for Civil Rights offers the following HIPAA guidance for health care professionals:

HHS Office for Civil Rights, Uses and Disclosures for Treatment, Payment, and Health Care Operations:
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html

HHS Office for Civil Rights, Minimum Necessary Requirement:
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/minimum-necessary-requirement/index.html

HHS Office for Civil Rights, Business Associates:
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/business-associates/index.html

Under Louisiana Revised Statute 37:1747, each board licensing health care providers must establish administrative rules on practice requirements based on CDC guidelines to protect the public against the transmission of Hepatitis B or the HIV virus.

Upon receipt of written informed consent of patients, health care providers may test them for HIV. For a copy of Test for HIV Infection Written Informed Consent Form, contact:
Louisiana Department of Health and Hospitals
Office of Public Health – HIV/AIDS Program
234 Loyola Avenue, 5th Floor
New Orleans, LA 70112
504-568-7474
hivweb@dhh.state.la.us
https://ldh.la.gov/page/928 

With few exceptions for special circumstances, a health care provider must have a patient’s written permission to release information on test results. The provider should review the release form with the patient to ensure that the patient understands the form’s content and purpose. If that patient is illiterate or does not read or speak English, an appropriate translator (i.e., interpreter for the deaf, blind, foreign language, etc.) must be furnished. In order to comply with the privacy regulations of HIPAA (the Health Insurance Portability and Accountability Act), it is recommended that a consent form for the release of information should state the following:

• the purpose of the disclosure;
• the patient’s right to review the health care provider’s privacy notice; and
• an explanation of the process by which the patient may revoke or request restrictions on the consent to disclosure.

The signed release form should be dated and kept on file by the health care provider for at least six years. The patient may cancel permission to release results at any time, except when the information has already been released. 

Under Chapter 12 of the Rules of the Louisiana State Board of Dentistry (LSBD), any dental health care provider who is seropositive for HBV, HCV or HIV, and who in the course of practice may perform or participate in an exposure-prone procedure, must properly report their status and receive authorization from a board-appointed expert review panel before they may perform any exposure-prone procedures. Such reports are completely confidential, except as may be necessary to investigate or prosecute suspected violations.

Under the American Dental Association’s Principles of Ethics and Code of Professional Conduct, any dentist who becomes impaired in any way is urged to seek medical advice and treatment from a qualified professional and to limit his/her practice activities to areas that will not endanger patients or dental staff. For more information, contact:
Louisiana State Board of Dentistry
1201 North Third Street
Suite G-136
Baton Rouge, Louisiana 70802
225-219-7330
www.lsbd.org

Beginning October 1, 2015, any provider billing a CPT code is required to use ICD-10 diagnosis codes. (This primarily affects oral surgeons and dentists who perform reconstructions following accidents, surgeries, cancer, etc. and bill using medical (CPT) codes to Bayou Health.)

Dentists billing CDT codes will not be required to use ICD-10 codes when filing a claim with MCNA or Fee-For-Service (FFS). Currently recipients that reside in an Intermediate Care Facility for the Developmentally Disabled continue to receive dental services via FFS, with claims paid by Molina.

Dentists who bill procedure codes that require a diagnosis code must use ICD-10 when billing for both Bayou Health and FFS members. The Bayou Health 2.0 contract (effective 2/1/15) provides coverage for surgical dental services. Therefore any medically necessary oral surgery or reconstructive dental surgery claim using CPT codes should be submitted to the respective health plan if the member is enrolled in Bayou Health. For those that are not enrolled in a Bayou Health plan, surgical claims utilizing CPT codes should continue to be sent to Molina.   

The links below were placed on the Louisiana Medicaid website with additional information regarding the ICD-10 transition.

9/18/15 ICD-10 Testing Information Update: http://www.lamedicaid.com/provweb1/HIPAA/ICD-10_Testing_Information_Update_9-18-15.pdf

9/15/15 ICD-10 Information Update: http://www.lamedicaid.com/provweb1/HIPAA/ICD-10_Information_Update_9-10-15.pdf

9/10/15 ICD 10 Q&A: http://www.lamedicaid.com/provweb1/HIPAA/ICD-10_QA_9-10-15.pdf

8/7/15 ICD-10 Implementation Webinar Presentation: http://www.lamedicaid.com/provweb1/HIPAA/ICD-10_Implementation_Webinar_8-7-15.pdf 

7/6/15 ICD-10 Outreach: http://www.lamedicaid.com/provweb1/default.htm

The Centers for Disease Control has issued universal precautions advising health care providers to use the same protective measures which would prevent the transmission of the AIDS virus or other infectious disease with all patients.  These precautions include:

• Wearing gloves, masks and protective eyewear.
• Washing hands before and after each treatment.
• Changing gloves after each patient.
• Disposing of needles and other sharp items in special containers.
• Properly disposing of waste items and contaminated material.

HIV infection alone does not justify the limiting of professional duties or automatically mandate disclosure, unless the dental health care worker poses a risk of transmitting infection through non-compliance with universal precautions, a lack of infection control competence or shows signs of functional impairment.

The CDC publication Recommended Infection-Control Practices for Dentistry is included in the booklet published by the Louisiana State Board of Dentistry and may be ordered or accessed online through the Centers for Disease Control - Division of Oral Health, 770-488-6054, or 888-CDC-FACT (232-3228) for automated information or www.cdc.gov.

The LA State Board of Dentistry infection control checklist

Under Louisiana Revised Statute 40:1299.131, a dentist must receive consent for any dental treatment after the patient has been informed in general terms of the nature and purpose of the dental treatment and the risks of death, brain damage, quadriplegia, paraplegia, loss or loss of function of an organ or limb, or disfiguring scars associated with specific dental treatment. The patient must be given an opportunity to ask questions about the treatment and have them answered satisfactorily. The dentist has the responsibility of obtaining written informed consent of a patient, but this responsibility may be delegated to a lay or professional employee of a hospital or dental office. For more information, contact your malpractice insurer carrier or the LDA at 800-388-6642, 225-926-1986 or e-mail: info@ladental.org.

Fortress Insurance Company is a professional liability company created by dentists, for dentists. Fortress has developed a comprehensive risk management program uniquely designed for the dental office. Fortress has provided sample informed consent documents for LDA members. Their goal is to educate dentists and their staff about current risk management techniques that enhance patient care and help reduce liability exposure. To learn more about how Fortress Insurance Company can protect you and your practice, email Stormy Blair at Brown & Brown at Stormy.Blair@bbrown.com. 

The LDA sponsors the following types of insurance coverage through its administrator, Brown & Brown:

• Major Medical
• Business Overhead Expense
• Personal Accident
• Term life
• Disability Income
• In-Hospital Indemnity
• Medicare Supplement
• Long Term Care

Distinguishing between fully insured and self-insured plans on ID cards, La. R.S. 22:984 (legislation sponsored by the LDA), makes it simple to distinguish between fully insured and self-insured (ERISA) plans by requiring the former to print the words “Non-ERISA” on patients’ insurance ID cards. This can be very important to dentists, since self-insured plans are exempted from many of state laws.

Louisiana Revised Statute 23:965: Any person who is regularly employed in the state of Louisiana shall, upon call or subpoena to serve on a state petit or grand jury, or central jury pool, be granted a leave of absence by his employer, of up to one day, for that period of time required for such jury duty. Such leave of absence shall be granted without loss of wages, or sick, emergency, or personal leave or any other benefit. It prohibits an employer from discharging an employee, without cause, who has been called to serve on jury duty. 

Louisiana Revised Statutes 9:2799.5 limits the civil liability of health care providers for gratuitously rendered care to instances of gross negligence or willful or wanton misconduct. For providers to enjoy this limited liability, the treatment must be rendered: (1) in a community health care clinic, or (2) in the provider’s office pursuant to an arrangement with a community health care clinic and for a patient who has been screened by the community health care clinic and found to be financially eligible to receive gratuitous services. Under this statute, a patient’s financial eligibility is defined generally as having no access to health care benefits through a public entitlement program for the treatment rendered. In other words, the patient must not be eligible for Medicaid, Medicare, LaCHIP, etc. Most community health care clinics also require that the patient may not have private insurance coverage.

In addition, either at the time of the initial screening or at the time health care services are provided, the clinic or provider must give the patient written notice of the limitation of liability and conspicuously post a similar notice of the limitation of liability for patients to see.

More detailed information is available in the LDA information sheet, Limited Liability for Gratuitous Provision of Health Care Services. To obtain a copy, contact the LDA at 800-388-6642, 225-926-1986 or email info@ladental.org.

Jan. 2, 2013 - There are still many unanswered questions about how the medical device excise tax, which is part of the Affordable Care Act, will be applied.  The following is the most current information obtained by the ADA at this point: http://www.wsda.org/news/blog/archive/2012/12/17/medical-device-tax-update.html. The ADA has also compiled a list of "dental devices" as defined by the FDA. You can view or print this list by visiting: http://www.ada.org/en/advocacy/excise-tax-alert/21-cfr-part-872-dental-devices.

Louisiana Revised Statutes 40:1299.41, the Louisiana Medical Malpractice Act, defines malpractice as “any unintentional tort or any breach of contract based on health care or professional services rendered, or which should have been rendered, by a health care provider, to a patient, including failure to render services timely and the handling of a patient, including loading and unloading of a patient, and also includes all legal responsibility of a health care provider arising from acts or omissions in the training or supervision of health care providers, or from defects in blood, tissue, transplants, drugs and medicines, or from defects in or failures of prosthetic devices, implanted in or used on or in the person of a patient.”

According to Louisiana Revised Statues 9:5628, “no action for damages for injury of death against any physician, ... dentist, ... hospital duly licensed under the laws of this state, or community blood center or tissue bank as defined in R.S. 40:1299.41(A), whether based upon tort, or breach of contract, or otherwise, arising out of patient care shall be brought unless filed within one year from the date of the alleged act, omission or neglect, or within one year from the date of discovery of the alleged act, omission or neglect; however, even as to claims filed within one year from the date of such discovery, in all events such claims shall be filed at the latest within a period of three years from the date of the alleged act, omission or neglect.”

Louisiana Revised Statute 40:1299.96 requires health care providers to furnish to a patient or his legal representative, upon request, copies of any information related to the patient, which the health care provider has transmitted to any company, agency or person. The law states that the patient’s medical records are the property and business records of the health care provider. If the original treatment records are generated, maintained, or stored in paper form, the law authorizes the following schedule of charges for copies requested:  1 - 25 pages:  not to exceed $1 per page; 26 - 350 pages:  not to exceed $.50 per page; and $.25 per page thereafter; handling charge: not to exceed $25 for hospitals, nursing homes and other health care providers and actual costs incurred for postage.

If treatment records are generated, maintained, or stored in digital format, copies may be requested to be provided in digital format and charged at the rate provided by this item; however, the charges for providing digital copies shall not exceed $100, including all postage and handling charges actually incurred.  Also: x-rays, microfilm and electronic and imaging media, upon payment of reasonable reproduction costs and a handling charge of $20 for hospitals; $10 for other health care providers. If the patient X-rays and other imaging media are generated, maintained, or stored in digital format, copies may be requested to be provided in digital format and charged at the rate provided by this item; however, the charges for providing digital imaging media copies shall not exceed $200, including all postage and handling charges actually incurred. If requested, the health care provider shall provide the requestor, at no extra charge, a certification page setting forth the extent of the completeness of records on file. In the event a hospital record is not complete, the copy of the records furnished shall indicate, through a stamp, coversheet, or otherwise, the extent of completeness of the records. Each request for records submitted by the patient or other person authorized to request records pursuant to the provisions of this Subparagraph shall be subject to only one handling charge, and the health care provider shall not divide the separate requests for different types of records or X-rays, including but not limited to billing or invoice statements. The health care provider or person or legal entity providing records on behalf of the health care provider shall not charge any other fee which is not specifically authorized by the provisions of this Subparagraph, except for notary fees and fees for expedited requests as contracted by the parties.

The health care provider must comply with requests in at least 15 days. Any court-ordered records will require the health care provider to pay reasonable expenses and attorneys fees. Access to records may be denied only if the knowledge of the information would be harmful to the health or welfare of the patient or any other person.

Medical records should be retained for a minimum of six years from the date of last treatment. Graphic matter, images, x-ray films, and such data should be retained for three years from the date of last treatment, unless the patient requests a longer period in writing.

The Office of Public Health regulates the management and disposal of medical waste, infectious waste and potentially infectious biomedical waste. Among the requirements of the Sanitary Code (Title 40 of the Louisiana Revised Statues), is the requirement that used sharps be encased so as not to produce injury. A copy of the Sanitary Code on Management of Refuse, Infectious Waste, Medical Waste, and Potentially Infectious Biomedical Waste, Chapter XXVII, may be ordered or viewed online via:
DHH Office of Public Health
Infectious Waste Program
6867 Bluebonnet Blvd.
Baton Rouge, LA 70810
225-763-5553
Sanitary Code on Management of Refuse, Infectious Waste, Medical Waste, and Potentially Infectious Biomedical Waste

It has come to the attention of the LDA that some providers of medical waste disposal services operating in Louisiana have been telling LDA members that they need to contract an additional service to handle pharmaceutical waste generated in the members’ practices. This is not the case in the state of Louisiana, though it is in many other states that default to the regulatory standards of the federal Clean Water Act.  However, larger waste disposal companies that operate in multiple states generally standardize their operations to be compliant in any state.

It should be noted that the LDA’s endorsed medical waste disposal service, Medical Waste Management (MWM), is locally owned and operated and thus does not have to contend with the same regulatory requirements as a larger company that operates in multiple states. As long as your office’s pharmaceutical waste does not include a Schedule 2 Narcotic or RCRA drugs, MWM can pick it up along with your other medical waste at no additional charge.  In the case of Amalgam, a special bucket is needed due to its mercury content, and there is a one-time additional fee. Moreover, MWM can offer a limited, inexpensive pharmaceutical waste only option for those members who currently have long-term contracts with other companies for medical waste disposal but don’t wish to purchase second pricey contract from the same company.  These are just a few ways that MWM can offer added value to LDA members.

If you are looking for an alternative to your current waste disposal service, or simply want to know more about your options, contact the MWM team at 985-373-6428 to discuss your situation.  They’ll be happy to review all the possible options with you. You can also visit their website at www.medwastemgmt.net or contact Mark Grillo at Mark@medwastemgmt.net. MWM is endorsed by the LDA.

Dentists who treat Medicare patients must either enroll in the program or opt out in order to prescribe medication to their qualifying patients with Part D drug plans. So, if you are a dentist who writes prescriptions for elderly patients on Medicare, you need to opt in.

(The rule is not final but the following is the intention of CMS)

The Center Medicare and Medicaid Services (CMS) will be extending to Jan. 1, 2016 the effective date by which dentists must have either enrolled or officially opted out of Medicare in order for prescriptions they write to be covered by Medicare Part D. This proposed rule would also require Part D plans to cover a "provisional supply" of up to 90 days of a medication prescribed by a doctor who has not enrolled or opted out. A Part D plan must notify the beneficiary in writing within three business days that the medication is being covered on a provisional basis because of the prescriber's current Medicare status. Part D plans must also make reasonable efforts to notify the prescriber. After covering the provisional supply and providing the notice to the beneficiary, the Part D plan will be required to reject future claims for the same medication for that beneficiary if the prescription is from the same prescriber.

In a conversation with CMS today we confirmed that “opting out” is not an option for any provider who treats patients in a Medicare Advantage plan and wishes their patients to receive the benefit from the MA plan. This is true whether the provider is in-network for the MA plan or not (for PPO-type MA plans). The MA organization is required to check the opt out list on a regular basis. Remember if a dentist has already opted out they can reverse their decision within 90 days. 

We also confirmed that enrolling either using the 855I (full enrollment) or the 855O (ordering and referring provider) are valid options for a dentist treating patients with an MA plan.

If a non-contracted dentist enrolls in Medicare using the 855i this does not mean the dentist is now an MA plan participant i.e. in-network for the MA plan.

The video that ADA has on CPS continues to be the most accurate information we have on this topic (other than the change in date noted above) -- http://success.ada.org/en/practice/medicare/medicare/medicare-overview-video-tutorial

The ADA has a slew of information readily available on its website regarding the opt in/out deadline for Medicare.  There is even a flow chart of sorts that should make it fairly easy for dentists to decide whether or not they should enroll.  The info can all be accessed from:http://www.ada.org/en/member-center/member-benefits/legal-resources/publications-and-articles/reimbursement/medicare-enrollment-decision-tool-introduction-medicare-enrollment/medicare-enrollment-faq

The National Practitioner Data Bank (NPDB) contains information about dentists and other licensed health care practitioners who have had adverse actions taken against them with respect to their professional competence or conduct, or who have had payments made on their behalf in response to written claims of malpractice. The U.S. Department of Health & Human Services operates the NPDB. Its purpose is to improve the quality of health care by encouraging hospitals, state licensing boards and other health care entities, including professional societies, to identify and discipline those who engage in unprofessional behavior, and to restrict the ability of incompetent health care practitioners to move from state to state without disclosure or discovery of previous damaging or incompetent performance. Health care providers also have access to the files. For more information, contact the American Dental Association at 800-621-8099 or www.ada.org or the National Practitioner Data Bank at 800-767-6732 or www.npdb-hipdb.com.

The National Provider Identifier (NPI) is a unique, government-issued, standard identification number for individual health care providers and provider organizations like clinics, hospitals, schools and group practices. The government has contracted with an external company for processing applications and developing these random 10-digit numbers for applicants. Applications to obtain an NPI began on May 23, 2005.

Anyone who uses standard electronic transactions, like electronic claims, eligibility verifications, claims status inquiries and claim attachments, will be required by federal law to start including NPIs on electronic transactions not later than May 23, 2007. In addition, those dentists who use only paper, voice and fax to transmit these communications may find NPIs useful or necessary for other reasons. The ADA encourages all dentists to apply for NPIs, particularly those using (or planning to use) electronic transactions.
The NPI has some advantages over identifiers now in use:

           Once implemented across the health care industry, the NPI will be accepted by all dental plans as a valid provider identifier on   electronic dental claims and other standard electronic transactions.

           Dentists will not have to maintain multiple, arbitrary identifiers required by dental plans, nor will they have to remember which number to use with which dental plan.

           Introduces an important element of standardization to electronic transactions that should improve transaction acceptance rates.
          
However, the NPI does not do any of the following:

           Replace the DEA number when required for prescribing controlled substances or other DEA-regulated activities.

           Replace state-issued licenses and certifications verifying a provider's licensing or qualifications.

           Replace Social Security Number, Individual Tax ID, or Employer ID for tax purposes.

Early application for and receipt of an NPI mean your practice will be ready to submit NPI data when requested by a patient’s health plan, a clearinghouse, your system vendor, or a fellow health care provider who needs it for billing purposes. It is very likely that plans will begin requesting NPIs prior to May 23, 2007, for electronic transactions. Even if a dentist does not use electronic transactions, it is quite likely that a health plan might require the dentist to use an NPI on paper claims.

Applying for an NPI is free and relatively easy: Visit https://nppes.cms.hhs.gov/NPPES/Welcome.do, read the instructions carefully, complete the questionnaire and submit your application. This takes about 20–30 minutes. After confirmation of your data’s receipt, you should receive your NPI via e-mail in one to five business days. A downloadable application form is also available. Download the application form, print, complete and mail per the instructions. The NPPES does not accept faxed applications. Processing of paper applications takes about 20 business days.

Act 26, passed during the 2021 Legislative Session requires transparency in network leasing. The National Coalition of Insurance Legislators (NCOIL) adopted model legislation regarding network leasing.  Network leasing by dental insurers has become a challenge in a number of states, including Louisiana. The LDA filed a bill that modeled NCOIL’s suggestions. The model act is all about transparency for the dentists who often inadvertently sign into contracts with leasing companies and/or dental plans without understanding they have agreed to a leasing arrangement that opens up their office to both existing and new patients at a fee level that is below their usual and customary fees. The LDA introduced this model legislation to bring transparency to network leasing and to provide consumer protection.

La. R.S. 22:1157 ensures no dental plan in LA can require a dentist to sign a contract that obligates him/her to provide a service to a covered person at a particular fee unless it is a covered service for which the plan pays a benefit.

In the 2010 Legislative Session, the LDA sponsored a non-covered services bill. This bill said that no dental plan that is contracted for in this state may require that a dentist provide dental health care services to a covered person at a particular fee unless such services are covered services for which benefits are paid under a contract with such dentist. It also clarifies that a dental service contractor or insurer may offer a dentist optional agreements for participation in a dental plan in which a dentist may CHOOSE to participate either with or without a provision to provide discounts to covered persons for non-covered services. This law became effective January 1, 2011.

The Occupational Safety and Health Act was enacted in 1970 to prevent work-related injuries, illnesses, and death. Health care professions are primarily affected by two standards of the Act: the Bloodborne Pathogens Standard and the Hazard Communication Standard. These standards address specific guidelines for employee health and safety.

The Bloodborne Pathogens Standard requires employers to formulate a written exposure control plan, identify workers with occupational exposure to blood and saliva, and specify protection and training for them. This plan should be reviewed and updated regularly and made available to employees. Guidelines for compliance with post-exposure requirements under this standard are available at http://www.ada.org/en/. Needle safety regulations added to the Bloodborne Pathogens Standard in 2001 have little impact on dental offices; dentists are not required to adopt new injection technologies unless they decide that a new device will be safe, effective, and appropriate for their practice.

The Hazard Communication Standard ensures that both employers and employees know about chemical hazards in the workplace and how to protect themselves through proper handling. Employers must maintain a library of Material Safety Data Sheets (MSDS) on all hazardous materials in the workplace, or have access to the appropriate MSDS in an emergency; check that hazardous materials are properly labeled; train employees to handle those materials; and make a written plan for your office available to employees.

Other OSHA standards and guidelines address fire extinguishers, fire exits, ergonomics, and other factors that could harm employees. Dental offices were exempted from certain OSHA record-keeping requirements that took effect in 2002 relative to sharps injuries, work-related injuries, and illnesses. However, OSHA and/or state agencies may still ask a dental office to keep certain injury records. If you receive a letter from OSHA stating that a formal or informal complaint has been received against your office, notify the LDA immediately.

The ADA has developed a Regulatory Compliance Manual and training resources with all necessary information for dental professionals’ compliance with OSHA standards. To order these materials, visit www.adacatalog.org or call 1-800-947-4746. OSHA regulations are modified frequently, and LDA members are urged to contact the U.S. Department of Labor with specific questions about current OSHA standards. You may obtain a copy of current OSHA standards from:
U. S. Department of Labor
OSHA Publications Office
Post Office Box 37535
Washington, DC 20013-7535
800-321-OSHA
www.osha.gov

The Louisiana Department of Labor, Office of Workers’ Compensation, has an OSHA Consultation Division, which will conduct a confidential, free inspection of dental offices upon request. A report of the inspection will be given to the dentist, but not to OSHA. This division also provides copies of sample Exposure Control Plans to assist providers in complying with OSHA’s Bloodborne Pathogens Standard, as well as programs and educational material to groups of providers. For more information, contact:
OSHA Consultations Office
1001 North 23rd Street, Room 230
P.O. Box 94094
Baton Rouge, LA 70804-9094
225-342-9601

The Louisiana Dental Practice Act, as amended in 2001, allows a spouse or personal representative of a deceased or disabled dentist to contract with a licensed dentist to manage the existing dental practice of the deceased/disabled dentist for a maximum period of 24 months. The 24-month period begins once the dentist is declared legally dead, or as soon as the spouse/personal representative files a verified copy of disability status with the State Board of Dentistry. The law places further restrictions on the spouse/personal representative who retains temporary ownership of a dental practice under these circumstances. More detailed information is available in the LDA’s information sheet, Dental Practice Ownership by the Spouse of a Deceased or Disabled Dentist. To obtain a copy, contact the LDA at 1-800-288-6642 or 225-926-1986 or email info@ladental.org.

Under the Louisiana Medical Malpractice Act, a fund to pay the difference of medical malpractice awards in excess of $100,000 and up to $500,000, with unlimited future medical payment, was established in 1975. Dentists may participate in the fund by paying a surcharge through their primary medical malpractice carrier. Self-insureds may also participate. For more information, consult with your malpractice insurance carrier, or call the Patients’ Compensation Fund at 225-342-8784 or http://www.doa.la.gov/Pages/pcf/index.aspx.

Any dentist who serves on a peer review committee or as a consultant to such committee (established by a dental society or association) shall not be liable for damages resulting from any action taken or recommendation made by him/her while functioning in that capacity, if such action was made without malice. Refer to Louisiana Revised Statutes 37:1733, which may be found in the back of the booklet published by the Louisiana State Board of Dentistry.

Pre-existing conditions (Act 256, passed during the 2020 Legislative Session) prohibits the denial of claims based upon preexisting conditions. Also called the “missing tooth clause” bill, the law prevents a dental service contractor from denying a benefit for covered dental services to treat conditions existing prior to the date the coverage begins. A dental service contractor may impose up to a 12-month waiting period for covered services.

Dentists qualified to dispense or administer controlled substances are required to properly label all such substances and to maintain prescription files on any controlled substance that is sold, administered, or dispensed. The Louisiana Dental Practice Act (La. R.S. 37:794) requires that daily records be kept for all dispensations and administrations, which shall include the following information: identity of the controlled substance; identity of the person to whom the substance was dispensed or administered; date of dispensation or administration; and amount of the substance dispensed or administered.

La. R.S. 22:1009 states that a dentist who has already been credentialed by an insurer at one practice location shall be considered credentialed at any other location upon written notice from the dentist as long as another dentist credentialed by that plan had been practicing there at least 30 days prior.

The State Department of Environmental Quality requires dentists to register their radiograph equipment. The initial cost of registration is $115. Dentists are also required to maintain a copy of Chapters 1, 2, 4, 6 and 10 of the DEQ Radiation Protection Regulations in their dental offices.

To request permit form DRC-6:
Department of Environmental Quality
Licensing and Registration Section
P.O. Box 4312
Baton Rouge, LA 70821
225-219-3041
Download directly from the DEQ website at https://deq.louisiana.gov/resources/category/radiation-forms-guides-and-information
LDEQ Website: http://deq.louisiana.gov/

Medical records should be retained for a minimum of six years from the date of last treatment. Graphic matter, images, x-ray films, and such data should be retained for three years from the date of last treatment, unless the patient requests a longer period in writing.

Required Coverage for Cleft Palate, Pediatric Hospital Anesthesia and TMJ – La. R.S. 22:1026, 1040 & 1055 respectively require that state-regulated health insurance plans must cover treatment for each of these. The TMJ mandate is effective upon issuance or renewal for all large group (50+) plans beginning 1/1/18.

Quite a few dentists at the end of their careers, while no longer desiring or needing to practice regularly for compensation, still enjoy the idea of giving back to their communities by providing gratis care in community clinics, schools and/or Mission of Mercy events. The LDA and the State Board of Dentistry worked together to develop legislation that made the requirements for this license a bit more practical, thus expanding the potential availability of free dental care in Louisiana.

Because the LDA lobbied for expanded sales tax exemption that passed in 2002, many dental supplies are exempt from sales tax, thus saving practices thousands of dollars. The LDA also pursued and received a Revenue Ruling from the La. Department of Revenue in November 2004 regarding sales tax exemption. Louisiana grants a sales and use tax exemption on dental devices that are used exclusively by a patient or administered exclusively to a patient during health care treatment. On November 15, 2004, the Louisiana Department of Revenue and Taxation issued Revenue Ruling No. 04-008, which clarifies the department’s interpretation of an expanded sales tax exemption on dental devices. As a result, most Louisiana dentists are paying significantly less in sales taxes than they did before that date.

The U.S. Postal Service requires dentists to dispose of sharps in the following manner when mailing used sharps and devices:

1. Used sharps mailed through USPS must be sent first class or priority mail and must bear the international biohazard symbol;
2. Used sharps must be properly packaged in authorized containers and accompanied by a manifest;
3. Dentists should indicate on any container used to mail sharps the container manufacturer’s name, USPS authorization number, and container ID number or model number; and
4.  Containers must be securely sealed before mailing; liquid content may not exceed 50 ml; they must contain sufficient absorbent material; and they shall not exceed 35 pounds. Primary burden for compliance rests with manufacturers and distributors of mailing kits.

For more information, visit www.usps.com.

Louisiana Revised Statute 40:2203.1.B states that “a preferred provider organization’s alternative rates of payment shall not be enforceable or binding upon any provider unless such organization is clearly identified on the benefit card issued by the group purchaser or other entity accessing a group purchaser’s contractual agreement or agreements and presented to the participating provider when medical care is provided.” Under this law, the contract rate that will apply for service rendered is that which applies to the first Louisiana-domiciled PPO plan listed on the benefit card. If no Louisiana-domiciled plan is listed, the rate applied is for the first out-of-state PPO listed. Violators of this law are subject to penalties of up to double the fair market value of the services, but not less than the greater of $50 per day of noncompliance or $2,000, together with attorney fees to be determined by the court.  A provider may institute this action in any court of competent jurisdiction. For more information, contact the LDA at: 800-388-6642, 225-926-1986 or e-mail: info@ladental.org.

The Louisiana State Board of Dentistry is the state agency that regulates the practice of dentistry, including licensure, disciplinary action, continuing education monitoring, and enforcement of the State Dental Practice Act and the Board’s rules and regulations. The Board strongly recommends that all licensed dentists familiarize themselves with the booklet published by the Board, containing the current State Dental Practice Act and the rules, regulations and appendices that govern dentistry. For a copy of this book, contact:
Louisiana State Board of Dentistry
One Canal Place, Suite 2680
365 Canal Street
New Orleans, LA 70130
504-568-8574
www.lsbd.org

Louisiana Revised Standard 47:297
H.(1)  The tax determined as provided in this Part shall be reduced by the lesser of the tax due or five thousand dollars per taxable year up to a maximum of five years for each taxpayer meeting all of the following criteria.

(2)  The taxpayer shall:

(a)  Be a certified medical doctor (M.D.) possessing an unrestricted license from this state to practice medicine, or be a dentist licensed by this state to practice dentistry.

(b)  If a certified medical doctor, establish and maintain, after July 1, 1991, the primary office of his practice within twenty miles of a community hospital not owned predominantly by other physicians, and both the office and the hospital shall be located more than twenty miles from the nearest incorporated city with a population in excess of thirty thousand persons, provided that the medical doctor shall have relocated from outside of the service area of the community hospital.

(c)  If a dentist, establish and maintain, after July 1, 2002, the primary office of his practice within a parish or other geographic area in the state designated as a Dental Health Professional Shortage Area (HPSA) by the U.S. Department of Health and Human Services' Bureau of Primary Health Care, Division of Shortage Designation (DSD) as per Section 332 of the Public Health Service Act. Subject to the limits of Paragraph (3) of this Subsection, the provisions of this Subsection will continue to be available to the dentist if the Dental HPSA designation is withdrawn after the practice is established at that location.

(d)  Agree to practice under the conditions set forth herein for a period of not less than three years. The tax reduction provided herein shall continue to be available for two additional years if the remaining conditions of this Subsection continue to be met.

(e)  Accept Medicaid and Medicare payments for services rendered.

(3)  The provisions of this Subsection shall be available to a physician or dentist for only one relocation and only for a maximum of five years. In the event that the physician or dentist ceases to comply with these provisions within the three-year period, all taxes reduced hereunder shall be subject to recapture pursuant to rules promulgated by the department

(This information was found on the Department of Health and Hospitals Web site at http://new.dhh.louisiana.gov/index.cfm/page/796)

All physicians, dentists, chiropractors, podiatrists, optometrists, etc. are required by law to have a UPIN if they refer Medicare beneficiaries or order services for them, even if Medicare is never billed directly. For a UPIN, contact:
Medicare Services
Post Office Box 83860
Baton Rouge, LA 70884-3860
225-231-2133

Title 23, Chapter 11 of the Louisiana Revised Statutes provides for short-term, partial wage continuance to those with a work history, who are unemployed through no fault of their own, and who are seeking work. With the exception of religious, charitable and educational organizations, all employers must join the fund. To protect themselves, employers are urged to:

1. Prepare detailed job descriptions;
2. Hold effective job interviews;
3. Establish a written hiring agreement; and
4. Establish a written disciplinary system and termination procedure.

For more information about employers’ obligations, contact: Louisiana Department of Labor, P.O. Box 94094, Baton Rouge, LA 70804-9094, 225-342-3202 or www.laworks.net.

Employers are also required to file federal unemployment tax returns annually.  For more information, contact: Internal Revenue Center, Memphis, TN 37501, 800-829-1040 or http://www.irs.gov/.

Insurance companies are required to disclose how they determine their “usual and customary” level of fee reimbursement for dental treatment. Any company licensed under Louisiana’s Insurance Code must provide patients the following data, if dental reimbursement is based on a “usual and customary” fee basis:

1. The frequency of fee data update to determine maximum allowance;
2.  A specific description of the method used to determine usual and customary fee, including geographical information and the percentile used to determine the maximum allowable benefit.

Insurers must make this information available to patients upon request. The LDA offers an information sheet entitled Usual and Customary Disclosure: The Law is on Your Side. For a copy, contact the LDA at 800-388-6642, 225-926-1986 or email info@ladental.org.

Revised Statute 9:2799.5 provides for a limitation of liability for gratuitous service by a health care provider in a community health care clinic or community pharmacy.

In order for there to be immunity from professional liability (except for gross negligence or willful/wanton misconduct) when a health care provider renders free care, three criteria must be met:

• The care must be provided in, or arranged through, a non-profit community clinic (as defined in the statute).
• Prior to the patient receiving care, the clinic must conduct a financial screening to determine that the patient is eligible to receive free care, including screening to determine whether the patient is eligible or enrolled in a public entitlement program (e.g., Medicaid, Medicare, etc.) that provides health care benefits.
• The patient must be informed in writing, either in a document handed to him/her or via a notice posted prominently at the location where the screening takes place, that he/she may not have the same legal recourse for anything that goes wrong in the course of receiving free health care.

Employers are required to secure workers’ compensation insurance for their employees through one of the following sources:

1. Workers’ compensation insurer;
2. Self-insurance;
3. Group self-insurance.

Failure to provide for workers’ compensation in one of the above ways can subject an employer to a fine of up to $10,000, imprisonment for up to one year, or both.

Additionally, employers must post a notice of compliance in a convenient and conspicuous place, which sets forth certain rights and responsibilities of injured employees. If the employer fails to post the notice, the time for giving notice of the injury shall be extended to 12 months from the date of injury. For a copy of the poster, visit www.laworks.net or contact:
State of Louisiana
Office of Workers’ Compensation
P.O. Box 94040
Baton Rouge, LA 70808-9040
225-342-7555

To obtain workers’ compensation insurance coverage, contact your local independent insurance agent.