Are You in Compliance?

A dental practice that administers general anesthesia or deep or moderate sedation must use a written informed consent form that includes language specified in AB 1622 which the governor signed October 2019. Check out CDA's news article for more information, and access updated informed consent forms from the Practice Support Resource Library.

EPA’s newest rule requires healthcare facilities and other businesses that generate pharmaceutical hazardous waste to properly dispose of the waste. The first part of the rule, the prohibition on “sewering” hazardous pharmaceutical waste, is effective August 21. All nonhazardous pharmaceutical waste that are not controlled substances must be disposed as regulated medical waste. See Dental Office Waste Management Options.

The following cities and county will increase their minimum wage on July 1: Alameda, Berkeley, Emeryville, Fremont, City of Los Angeles, County of Los Angeles (unincorporated areas only), Malibu, Milpitas, Pasadena, San Francisco, San Leandro and Santa Monica.

Dental facilities without amalgam separators on June 14, 2017, with exceptions, must install an amalgam separator by this date and comply with documentation requirements. Separators must be compliant with either the American National Standards Institute (ANSI) American National Standard/American Dental Association (ADA) Specification 108 for Amalgam Separators (2009) With Technical Addendum (2011) or the International Organization for Standardization (ISO) 11143 Standard (2008) or subsequent versions so long as that version requires amalgam separators to achieve at least a 95 percent removal efficiency.

Dentists who order or provide Medicare-covered items and services (clinical laboratory services, imaging services or durable medical equipment, prosthetics, orthotics and supplies) will need to either enroll in Medicare using form CMS-855-I (PDF) or the shorter enrollment form CMS-855-O (PDF) or formally opt out of Medicare by Jan. 1, 2019. To assure one's status with Medicare and that patients' Medicare benefits do not lapse, dentists should allow sufficient time for processing whichever form is submitted. Learn more about enrollment requirements by visiting the ADA’s Facts and FAQ on Medicare.

See the IRS’s press release. For business expense reimbursement, the 2019 rate is $0.58 per mile. That’s up $0.035 from last year. California employers need to reimburse such common expenses as work-related travel, dining expenses and mileage when an employee uses a personal car for work-related business. However, employees who can prove they spend more than $0.58 per mile to operate their personal vehicles for business use may be entitled to reimbursement of the actual expense. It’s up to the employees to prove their expenses, however.

The new law amends the Labor Code to specify that an employer may now ask for an applicant’s salary expectations for the position being applied for, only external applicants (not current employees) and are entitled to request a pay scale for the position they are applying for, but only after completing an initial interview. The pay scale provided only needs to include salary and hourly wage ranges. AB 2282

Section 1031 of the Labor Code has now been updated to specify that employers should provide a location other than a bathroom. Employers must make reasonable efforts to provide the employee the use of a room, other than a bathroom, in close proximity to the employees work area to express milk in private. Employers should update their employee policy to reflect the new
lactation accommodation requirements. Sample Employee Manual (Doc)

The minimum wage for a large employer with 26 or more employees in California will increase from $11 per hour to $12 per hour, and employers with 25 or fewer employees will increase from $10.50 per hour to $11 per hour on Jan. 1, 2019. Some cities and counties have their own ordinances beyond what is required by state law, with more expected to follow. CDA provides a guide to minimum wage ordinances by city and county and employers are advised to check with their local jurisdictions to ensure they are in compliance.

When performing procedures on exposed dental pulp, water or other methods used for irrigation must be “sterile or contain recognized disinfecting or antibacterial properties.”

As of Jan. 1, 2019, a prescriber must offer a patient a prescription for naloxone hydrochloride or other FDA-approved drugs for the complete or partial reversal of opioid depression when one or more of the following conditions are present:

1. The prescription dosage for the patient is 90 or more morphine milligrams equivalent of an opioid medication per day. (See this CDC document on how to calculate MME.)
2. Opioid medication is prescribed concurrently with a prescription for benzodiazepine.
3. The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.

Additionally, a prescriber must provide education to a patient, or the patient’s guardian if the patient is a minor, receiving a prescription per the above circumstance on overdose prevention and the use of naloxone hydrochloride or other FDA-approved drugs for the complete or partial reversal of opioid depression. AB 2760

Beginning Jan. 1, 2019, a prescriber is required to discuss the following with a minor or the minor’s parent or guardian before issuing the first opioid prescription in a single course of treatment:

1. The risks of addiction and overdose associated with the use of opioids.
2. The increased risk of addiction to an opioid to an individual suffering from both mental and substance-abuse disorders.
3. The danger of taking an opioid with benzodiazepine, alcohol or another central nervous system depressant.

A new informed consent form, Consent to Prescribe Opioid to a Minor, (Spanish version) has been developed and is available on the TDIC and CDA Practice Support websites.

SB 1109  requires a warning notice be prominently displayed on the label or container of an opioid dispensed to a patient for outpatient use. The notice must state: "Caution. Opioid. Risk of overdose and addiction." The law requires the notice be displayed "by means of a flag or other notification mechanism attached to the container."

As announced by the Department of Justice in April 2018, California’s Controlled Substance Utilization Review and Evaluation System (CURES 2.0) is ready for statewide consultation by prescribers. As of Oct. 2, 2018, prescribers must check a patient’s prescription history in CURES 2.0 before prescribing a Schedule II-IV substance, with some specific exceptions. Refer to CDA’s article on mandatory checks for information on the exception applicable to some dentists. Prescribers who have issues accessing CURES can email the DOJ or call 916.210.3187.

Belmont, Emeryville, Los Altos, City and County of Los Angeles, Malibu, Milpitas, Pasadena, San Francisco, and Santa Monica. Redwood City has joined the list of cities with a new $13.50/hour increase effective 1/1/2019.

The DFEH has stated that the change to this poster made in June 2018 is not a mandatory update.

The EDD released this new, mandatory posting on July 3, 2018 although the revision date is May 2018. EDD states that, while maintaining updated publications is always encouraged, employers can continue to use the previous version of their mandatory employer notice (DE 1857A) until January 1, 2019—at which time all employers must post the updated version.

On Jan. 11, 2018, the IRS issued revised tax withholding tables for employee paychecks. To comply with IRS Notice 1036, employers should implement the 2018 withholding tables as soon as possible, but no later than Feb. 15, 2018. The notice provides early release copies of the new percentage method tables for income tax withholding. To learn more about your tax responsibilities as an employer, refer to Publication 15 and recent developments at irs.gov.

The Division of Occupational Safety and Health under the California Department of Industrial Relations, commonly known as Cal/OSHA, has updated the Safety and Health Protection on the Job notice with a poster print date of October 2017. All employers are required to print and post this notice in an area frequented by employees where it may be easily read during the workday.

For all employers in the city of Berkeley, Calif., minimum wage increases to $13.75 and increased paid sick leave requirements also become operative effective Oct. 1, 2017. Detailed information and posting requirements about minimum wage requirements can be found on the City of Berkeley’s website. As part of paid sick leave requirements, covered employees accrue one paid sick leave hour for every 30 hours worked; the ordinance is silent with regard to front-loaded allowances. For small businesses, which employ fewer than 25 employees, there is a cap of 48 hours per year; for all other businesses, the cap is 72 hours, though employers can set a higher cap or no cap. Accrued but unused leave carries over from year to year — whether calendar or fiscal year — but cannot exceed the cap. Employers who don’t meet the minimum requirements may still be required to update their written paid sick leave policies.

Beginning Sept. 18, employers must use the revised I-9 form with a revision date of 07/17/17 N. From July 17–Sept. 17, they are permitted to use the previous form with a date of 11/14/16 N. The new version brings very subtle changes to the form’s instructions and a list of acceptable documents, which were created with the goal of making the form easier to navigate. Current storage and retention rules have not changed. Visit the United States Citizenship and Immigration Services website at uscis.gov/I-9.

With some exceptions, new dental facilities opened on or after June 14, 2017 (does not include purchase of existing dental facility) must install an amalgam separator by this date and comply with documentation requirements. Separators must be compliant with either the American National Standards Institute (ANSI) American National Standard/American Dental Association (ADA) Specification 108 for Amalgam Separators (2009) With Technical Addendum (2011) or the International Organization for Standardization (ISO) 11143 Standard (2008) or subsequent versions so long as that version requires amalgam separators to achieve at least a 95 percent removal efficiency.

PSL law will apply to employers with 25 or fewer employees as of July 1, 2017. The Los Angeles PSL ordinance contains different provisions than the state PSL law; employers within the city limits must comply with both state and local law. For each provision, protection or benefit, employers must provide whichever is more generous to the employee. Employers must also update their PSL policies accordingly.

Under AB 2337, California employers with 25 or more employees must provide written notice to employees of their rights to take protected leave for domestic violence, sexual assault or stalking. The notice should be provided to new employees and to other employees by request. The notice can be downloaded from the Department of Industrial Relations.

Dental facilities with amalgam separators on June 14, 2017 must replace that separator by this date and comply with documentation requirements. Separators must be compliant with either the American National Standards Institute (ANSI) American National Standard/American Dental Association (ADA) Specification 108 for Amalgam Separators (2009) With Technical Addendum (2011) or the International Organization for Standardization (ISO) 11143 Standard (2008) or subsequent versions so long as that version requires amalgam separators to achieve at least a 95 percent removal efficiency.

The California Department of Industrial Relations (DIR) has updated Wage Order 4-2001 to reflect the 2017 and 2018 increases in the state minimum wage. The DIR amended sections 4(A) and 10(C), which also reflect updated meal and lodging credit amounts. The correct industry Wage Order bears a revision date of “12/2016,” which is found on the bottom of the cover page for each Wage Order. Although the Wage Orders are dated 12/2016, they were just released by the DIR. Please note: this change comes after the 2017-18 CDA Required Poster Set printing. Each employer/practice owner is required to print and post the updated Wage Order over the top of the old Wage Order contained in the Required Poster Set. The Required Poster Sets will not be reprinted to reflect this change until the next print cycle in 2019.