Pursuant to ACA
17-82-601
et seq, the Arkansas State Board of Dental Examiners hereby promulgates these
rules to implement the practice of dentistry in mobile dental
facilities.
A.
Definitions
1.
MOBILE
DENTAL FACILITY
A self-contained, intact facility in which dentistry and dental
hygiene are practiced and that may be moved, towed or transported from one
location to another. For purposes of this Article, a mobile dental facility
does not include dentistry provided using portable equipment.
2.
OPERATOR
An individual licensed to practice dentistry in Arkansas. An
operator of a mobile dental facility may contract with or employ other
dentists, dental hygienists licensed in Arkansas and may hire Registered Dental
Assistants, Certified Dental Assistants, dental assistants, laboratory
technologists and other personnel as needed. Each mobile dental facility can
have only one operator. One operator may hold permits for more than one mobile
dental facility but each facility must have its own permit.
3.
DENTAL HOME
A licensed primary dental care provider who has an ongoing
relationship with a patient where comprehensive oral health care is
continuously accessible, coordinated, family-centered and provided in
compliance with policies of the American Dental Association beginning not later
than one year of age.
4.
COMPREHENSIVE DENTISTRY
A mobile dental facility that accepts patients and provides
preventive treatment including examinations, prophylaxis, radiographs, fluoride
treatments and sealants but does not follow up with treatment when such
treatment is clearly indicated is considered to be abandoning the patient. A
comprehensive treatment plan must be established for each patient treated in
the mobile dental facility. Treatment that cannot be completed during the
initial visit must be scheduled at intervals no greater than ninety (90) days
apart until the treatment plan is completed or the patient chooses to cease
treatment. Arrangements must be made for treatment either by the operator, a
licensed specialist or other licensee who agrees to provide follow up care. If
such arrangements are not made, the operator will be construed to have
committed unprofessional conduct by patient abandonment and be subject to
disciplinary action by the Board. EXCEPTIONS: Dental services
provided in mobile dental facilities by students, faculty or volunteers in
programs sponsored by CODA accredited dental, dental hygiene or dental
assisting schools may be limited in scope and are exempt from the requirement
that comprehensive dentistry be provided.
5.
INFORMED CONSENT
A document informing the patient of all proposed dental
treatments, risks involved and alternative treatments available which must be
signed by the patient or parent/guardian of any minor or incapacitated person
before dental services can be provided in a mobile dental facility. This form
must meet all the elements described in Section D. 2. of this rule. Written
consent must be obtained for the initial visit for diagnostic and preventive
services. After the treatment plan is developed, a second consent, either in
written form which is signed by the patient, parent or guardian or a recorded
verbal consent from the patient, parent or guardian must be obtained before
additional dental services are performed on the patient.
6.
ACTIVE PATIENT
Any person who received any level of dental care in a mobile
dental facility within the preceding twenty-four months
B.
Physical
Requirements
All mobile dental facilities must comply with all applicable
federal, state and local laws, regulations and ordinances including but not
limited to those concerning radiographic equipment, flammability, construction,
sanitation, zoning, infectious waste management, universal precautions, OSHA
guidelines and federal Centers for Disease Control guidelines, all rules and
regulations of the Board. The operator must possess all applicable county,
state, and city licenses or permits to operate the unit at the location where
services are being provided. Further, each mobile dental facility must have the
following functional equipment:
1.
Ready access to a ramp or lift
2.
Sterilization system
3. Potable
water including hot water
4. Ready
access to toilet facilities
5.
Covered, non-cprrosive container for deposit of waste materials including
biohazardous materials
6.
Automated External Defibrillators
7. Radiographic equipment properly registered
and inspected by the Arkansas Department of Health
8. Communication device available 24 hours
per day, 7 days per week and capable of both making and receiving calls as well
as the ability to contact emergency services, i.e. ambulance, police, fire
stations, etc.
9. Smoke and carbon
dioxide detectors
C.
Documentation and Records Requirements
1. All written, printed or electronic
materials must contain the official business address (not a PO Box) and
telephone number
2. When not being
transported to or from a treatment site, all dental and office records must be
maintained at the official office business address
3. All records must be available to the Board
upon request and the cost of providing records is borne by the mobile dental
facility
4. All patient records
must be made available to patients wishing to transfer care to another provider
and to the later treating dentist(s).
D.
Information to patients
1. Display in facility
a. The license (or a photocopy of the
license) of each dentist or dental hygienist working in the mobile dental
facility shall be prominently displayed in the facility.
b. The permit to operate the mobile dental
facility shall be prominently displayed in the facility.
2.
Consent forms
A consent form must be obtained prior to the provision of any
dental service in a mobile dental facility. The form must be signed by the
patient or by a parent or guardian if the patient is a minor or an
incapacitated person. Written consent forms are required for the initial visit
for diagnostic and preventive services. Consent for subsequent treatment may be
written or verbal providing that the verbal consent is recorded and stored as a
part of the dental record.
A consent form must include at a minimum:
a. Name of dentist providing the service
b. Permanent office address
c. Telephone number that is
available 24 hours per day for emergency calls
d. Service(s) to be provided
If the patient is a minor, the consent form must also contain the
following questions and statement:
* Has the child had dental care in the past twelve months? []Yes
[]No
* If yes, please list the name and address of the dentist or
dental office where the care was
provided.____________________________________________________
* Does the child have an appointment scheduled at the dental
home? []Yes []No
* "I understand that I can choose to have any or all dental
treatment for my child at the dental home. I understand that all dental care
provided by my dental home or a mobile dental facility may affect future
benefits that the child may receive from private insurance, Medicaid (ArKids)
or other third party provider of dental benefits."
If the patient is an adult, the consent form must be signed by
the patient and contain the following statement:
* "I understand that I may choose at any time to receive care
from my dental home rather than from the mobile dental facility."
If the patient is an incapacitated person, the form must be
signed by the patient's legal guardian and contain the following statement:
* "I understand that I may choose at any time to take the patient
to his/her dental home for dental care rather than from the mobile dental
facility."
3.
Post-care information to patients
Each person receiving dental care in a mobile dental facility
must receive an information sheet at the end of the visit. The information
sheet must contain:
a. Name of
dentist or dental hygienist who provided the service
b. Telephone number and/or other emergency
contact number
c. Listing of
treatment rendered including, when applicable, billing codes, fees and tooth
numbers
d. Description of
treatment that is needed or recommended
e. Referrals to specialists or other dentist
if mobile facility is unable to provide the necessary treatment
f. Consent form or a recorded, verbal consent
for additional treatment or altered treatment plan when applicable
E.
Permit
requirements
1. Complete required
application forms provided by the Board
2. Pay fee of $5,000.00 as set by Arkansas
Code
17-82-602
3. The operator must be a dentist
licensed in Arkansas
4. List all
dentists and dental hygienists who will be providing care in the mobile dental
facility complete with their name, address, telephone number and license number
5. The official business address
(not a PO Box) where patient records including radiographs are maintained and
available for inspection and copying upon request by the Board
6. Communication device available 24 hour per
day, 7 days per week and capable of both making and receiving calls as well as
the ability to contact emergency services, i.e. ambulance, police, fire
stations, etc.
7. Written
procedure for emergency follow-up care for patients treated in the mobile
dental facility which must include:
a.
arrangements for treatment in a dental facility that is permanently established
in the area where services are provided (50 mile radius) OR
b. A statement that follow-up care will be
provided through the mobile dental facility or at the operator's established
dental practice location in this state or at any other established dental
practice in this state that agrees to accept the patient.
8. List of dentists who have agreed to
provide follow up care as indicated in Section E.,7.,b. of this rule. A signed
statement from each dentist agreeing to provide follow up care must be provided
with the application.
9. Evidence
of radiographic equipment registration and inspection by the Arkansas
Department of Health
10. Signed
statement that all required physical equipment is present and functioning
properly. A checklist of these items will be a part of the
application.
11. Copy of the
driver's license of any person who will be driving the mobile dental
facility.
12. Proof of general
liability insurance from a licensed insurance carrier for at least one million
dollars ($1,000,000.00)
13. Name of
established non-mobile dental facility with which the mobile facility is
associated
14. Be inspected by the
Board or the Boards designee prior to the start of operation
F.
Annual Report
An annual report for the previous year must be submitted to the
Board by January 10th of each calendar year, which
must include:
1. List of all
locations (street address, city, state) where mobile dental services were
provided
2. Dates when services
were provided
3. The number of
patient treated during the year
4.
The types of services provided and quantity of each type of service
a. Preventive- # of patients receiving
preventive services
b.
Restorative- # of fillings, stainless steel crowns, fixed prosthetics provided,
space maintainers
c. Surgical- #
of teeth extracted and other surgical procedures performed
d. Endodontic- # of root canal therapies,
pulpotomies provided or # of patients referred for endodontic services
e. Periodontal- # of patient
receiving periodontal services or referred for periodontal services
f. Prosthetics- # of removable prostheses
provided or # of patients referred for prosthetic services / Report may reflect
"not applicable" if services are limited to children under the age of 18.
g. Other- # of other services
provided that do not fall into the above standard categories,
G.
Notification
of Changes
1. The Board must be
notified within 10 business days of:
a. If
the mobile dental facility is sold
b. Any change relating to dentists to whom
patients are to be referred for follow up care
c. Any change in the procedures for obtaining
follow up or emergency care
d. Any
change of operator
2.
The Board must be notified within 15 business days of:
Any change of dentists or dental hygienists providing dental
services in the mobile dental facility
3. The Board must be notified within 30
business days of;
a. Any change of official
business address or telephone number
b. Cessation of operation
H.
Supervision of
personnel and delegation of duties
1.
Dental assistants must only work under the personal or direct supervision of a
dentist as provided in Article XVII of these rules.
2. Dental hygienist must only work under the
direct or indirect supervision of a dentist as provided in Article XI of these
rules but may not work under general supervision in a mobile dental facility in
accordance with Arkansas Code
17-82-603.(i).
I.
Cessation of
operation
1. The Board must be
notified within 30 days of the cessation of operation of any mobile dental
facility.
2. Patients must be
notified in writing or publication once a week for three consecutive weeks and
a copy Of the notice provided to the Board
3. Arrangements must be made for the transfer
of records for all patients including radiographs or copies thereof to
succeeding practitioners or at the written request of the patient, to the
patient or a dentist of the patients' choosing.
