Written Collaborative Agreement (WCA) with a Public Health Dental Hygienist

A public health dental hygienist who holds a valid license to practice dental hygiene in the Commonwealth issued pursuant to M.G.L. c. 112, § 51, and who has completed the appropriate training required by the Board and has either three years of full-time or an equivalent 4,500 hours of clinical experience shall practice in accordance with Board statutes and regulations and shall enter into a written collaborative agreement (WCA) with a dentist who holds a valid license issued pursuant to M.G.L. c. 112, § 45 or with the appropriate local or state government agency or institution pursuant to M.G.L. c. 112, § 51, where a dentist licensed pursuant to M.G.L. c. 112, § 45, is available to provide the appropriate level of communication and consultation with the dental hygienist to ensure patient health and safety. (1) A public health dental hygienist shall: (a) Enter into a written collaborative agreement (CA) which complies with the requirements at 234 CMR 5.08 before rendering treatment, advertising, or soliciting patients to provide any dental hygiene services in a public health setting pursuant to the collaborative agreement; (b) Maintain contact and document communication with the dentist with whom the public health dental hygienist has entered into a written collaborative agreement (WCA); (c) Practice in accordance with Board rules and regulations; (d) Practice in accordance with systems, policies and procedures established pursuant to Board statute and regulations; (e) Obtain written, signed informed consent of the patient or legal representative which complies with Board regulations contained in 234 CMR 5.08, informs the patient or legal representative that the services provided by the public health dental hygienist are not a substitute for a dental examination by a dentist and informs the patient that the patient or legal representative that the patient should obtain, or should have had a dental examination by a dentist within 90 days; (f) Provide each patient with a written Information Sheet at the conclusion of the patient's visit. Said Information Sheet shall, at a minimum, include the following: 1. Results of the dental hygiene evaluation; 2. The name(s) of the public health dental hygienists and any licensed dentist and other dental auxiliaries who provided services; 3. A description of the treatment rendered including, but not limited to, billed service codes and fees associated with treatment, and tooth numbers when appropriate; 4. Information on how to contact the public health dental hygienist, dental health services program director, mobile dental facility or portable dental operation permit holder (See 234 CMR 7.00: Mobile and Portable Dentistry); 5. If necessary, provide a referral for emergency assessment by a dentist; 6. When a referral is made, the patient or legal representative shall be referred to the patient's regular dentist if one is identified. If none is identified, then the patient or legal representative must be provided with the names of dentist(s), community health center(s) or dental school clinic(s) located within a reasonable geographic distance from the patient's home and with whom the public health dental hygienist or dental health services program had communicated with regarding the acceptance of referrals; 7. The name and signature of the public health dental hygienist; and 8. If the patient or legal representative has given consent for an institutional facility (e.g. school, nursing home) to access the patient's dental health records, then the dental hygienist shall also provide the institution with a copy of the information sheet. 5.08: continued (2) A dentist entering into a written collaborative agreement (WCA) with a public health dental hygienist, may, but is not required to, provide subsequent dental treatment to patients served under said agreement. (3) Written Collaborative Agreement (WCA). A collaborative agreement between a public health dental hygienist and a municipality or state agency or institution, or with a licensed dentist who holds a valid license issued pursuant to M.G.L. c. 112, § 45 shall, at a minimum, address all of the following: (a) Identify by name(s) the dentist(s) who shall be available to provide the appropriate level of communication and consultation with the public health dental hygienist to ensure patient health and safety; (b) Describe, with specificity, how communication and consultation between the dentist and public health dental hygienist will be accomplished, including the frequency and arrangements for back-up coverage when the dentist is not accessible to provide communication and consultation (e.g., during vacation, illness); (c) Provide the names, license numbers, addresses, telephone and facsimile numbers, and emergency contact information for the dentist(s) and public health dental hygienist; (d) Include an attestation from the public health dental hygienist which is signed under the pains and penalties of perjury that describes the public health dental hygienist's qualifications to practice as a public health dental hygienist and explicitly states that the dental hygienist has a minimum of three years of full-time or an equivalent of 4,500 hours of clinical experience as a registered dental hygienist and has completed all training required by the Board; (e) Identify entity(ies) and geographic area(s) where public health dental hygienist services will be provided pursuant to the collaborative agreement; (f) Specify the dental hygiene procedures to be provided and the populations to be served pursuant to the collaborative agreement; (g) Specify and describe responsibilities for creating, maintaining, storing, retrieving and providing for the confidentiality of patient records; (h) Specify and describe responsibilities for establishing systems, policies and procedures to ensure compliance with Board regulations, including but not limited to requirements of 234 CMR 5.00 and 7.00: Mobile and Portable Dentistry as may be applicable; (i) Specify and describe responsibilities for developing, implementing, and maintaining emergency medical protocols and for the provision of periodic review and training on same; (j) Include any considerations for age- or procedure-specific protocols as may be deemed necessary by the dentist or public health dental hygienist; (k) Include any considerations for medically-compromised patients as may be deemed necessary by the dentist or public health dental hygienist; (l) Outline responsibilities for billing and reimbursement for services rendered by the dental hygienist in the public health setting, if indicated; (m) Identify a process for the public health dental hygienist to legally obtain prescription products (e.g. chemotherapeutics, fluoride varnish) pertinent to the provision of dental hygiene services and which are to be utilized when rendering services in a public health setting; and (n) Term of the collaborative agreement, if applicable. The dentist and public health dental hygienist shall review and update the written collaborative agreement at least annually. (5) The dentist and public health dental hygienist shall immediately notify each other and, if applicable, the municipality, state agency or institution involved in the collaborative agreement of any disciplinary action imposed by the Board or any other governmental agency against his or her license to practice dentistry or dental hygiene in the Commonwealth. (6) A copy of the written collaborative agreement shall be maintained by the municipality, state agency or institution, licensed dentist, and the public health dental hygienist. Upon written request, said agreement shall be made available to the Board, or to a patient who received treatment pursuant to the agreement or his or her legal representative. 5.08: continued (7) Each public health dental hygienist shall maintain the following data to be reported to the Massachusetts Department of Public Health's Office of Oral Health on forms and in accordance with procedures and timelines established by that office: (a) The dates of each session with name and address of the site where public health dental hygiene services were provided; and (b) The number of patients served and the type(s) and quantity(ies) of each service provided.