WDA 2014 Sourcebook by Wisconsin Dental Association

Member Directory & Practice Guide 2014

Own Your Smile!

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WDA President Dr. Julio Rodriguez March 2014

On behalf of the Wisconsin Dental Association, I am pleased to provide you with this copy of the 2014 WDA Sourcebook (Member Directory and Practice Guide). A valuable, desktop reference, it is used year-round by our more than 3,200 member dentists, 160 member dental hygienists and dental office teams. The 2014 edition features: • NEW dentists-by-specialty listing in member directory • Updated WDA legislative priorities and legislator list • Two tabs for easy, quick reference • State dental licensure CE requirements • Revised frequently asked questions This year’s cover features the “Own Your Smile!” tagline for the WDA’s new public awareness campaign. The combination of declining membership, a slow-to-recover economy, reduced patient/dentist ratio and the Affordable Care Act is placing tremendous stress on the way dentistry is practiced in this country. While there are difficult challenges ahead, I can assure you that with your help and support the WDA will be ready for them. Being an optimist, I see these challenges as opportunities for growth. It is time to re-evaluate old ways and embrace the future. Although the WDA has dedicated leadership and staff, it is not enough - we need you! Our members are truly the fuel that feeds this huge machine and we simply can’t move forward without your commitment. Start by helping prospective patients “own their smile” and update your Find A Dentist profile. Potential patients can learn more about your practice, but can only view the information you provide. Update your profile and give residents in your community reasons to select you as their new dentist. We all must be open to new ideas, because the future is going to be different and we need to be flexible in order to help shape it. The WDA is our organization and it is what we make it. Dentistry has been wonderful to me and I encourage all of us to work together to make it even better. Thank you to WDA Insurance and Services Corp. for providing financial support for this valued resource and our sincere appreciation to our 12 sourcebook advertisers. I hope you and your staff find value in this 2014 edition of the WDA Sourcebook! Thank you for your ongoing membership and commitment to organized dentistry.

Dr. Julio Rodriguez WDA President 2013-2014 Brodhead jrodriguez@wda.org

Julio Rodriguez, DDS WDA President, 2013-14 P.S. Please let us know if you have suggestions for staff to consider before creating next year’s edition. We value your feedback.

The WDA Sourcebook is available for download 24/7 on WDA.org in a digital-flip format or PDF. Additional hard copies are available to members for $15. Contact ebultman@wda.org or 414-755-4110 to purchase another copy. 2014 WDA Sourcebook

ADA 9th District Trustee Dr. Gary Jeffers March 2014

The buzzword at the American Dental Association this year, and perhaps its biggest challenge in achieving growth in membership, is “alignment”. It has been described in many ways and in a variety of terms, including one touted by ADA President Dr. Charles Norman as the “power of three partnerships”. But what do we mean when we say it, and what do we have to do to achieve it? Due to work initiated in 2013, it has become clear that member growth is a critical need for the sustainability of organized dentistry. Our message throughout our tripartite structure must be consistent. Member value drives loyalty. It must start in dental school and continue throughout every dentist’s career, regardless of locale or type of practice. Reversing the curve on memberships market share decline, and increasing the net number of members and associated dues revenue at all levels of the tripartite is good for the association. The ADA is exploring solutions and identifying ways we can further support constituent and component dental societies. For this to succeed, we must rely on mutual trust (defined as integrity, intent, capabilities and results) at all levels across the tripartite. A key in this coordinated effort will be increased communication among tripartite leadership. The Membership Plan for Growth emerging from the ADA Council on Membership and the Members First 2020 strategic plan currently has been using the phrase “power of three” to guide development of collaborative strategies. The council has proposed the formation of a standing TRIO team. This tripartite coalition consists of ADA Board members, council representatives, constituent and component leaders and executive directors. It will to focus on key opportunities, review progress and monitor results. The TRIO team will identify shared goals and objectives, clarify roles and suggest new collaborative processes to foster innovative benefits and services. A report will be given at the ADA House in fall 2014. To facilitate the process, the ADA Board has appropriated funds to upgrade the association’s membership management software. Using one common technology system will offer value and enable the most consistent member service at all levels of the tripartite. As your new 9th District trustee, I pledge to voice your concerns at the ADA level, seek ways to provide consistent communication and increase member value. I believe success can only be achieved by listening and responding to our members. Your thoughts and ideas are important. I look forward to hearing from you as we move forward in implementing the “power of three” partnership.

Gary Jeffers, DDS, MS ADA 9th District trustee

2014 WDA Sourcebook

Dr. Gary Jeffers ADA 9th District Trustee Northville, Mich. jeffersg@ada.org

2014 WDA Sourcebook Table of Contents

Executive Office 6737 W. Washington St., Ste. 2360 West Allis, WI 53214 414-276-4520 or 800-364-7646 fax 414-276-8431 or 800-864-2997 info@wda.org

Legislative Office 122 W. Washington Ave., Ste. 600 Madison, WI 53703 (New address effective May 1, 2014) 608-250-3442 or 888-538-8932 fax 608-282-7716 or 888-822-2932

WDA.org Connect with us on:

The WDA used 2013 membership information contained in its database to create this directory. Every effort has been made to ensure the information is correct. The WDA relies on its members to report any address changes or corrections. If you find an error in your directory listing, please use the form on page 154 to notify us so we may correct our records.

Letter from WDA President...................................................................................1 Letter from ADA 9th District Trustee ......................................................................2 WDA Strategic Plan ...........................................................................................4 Find A Dentist Profile...........................................................................................5 Regions and Components................................................................................... 6 Officers and Trustees ..........................................................................................7 Component Officers ...........................................................................................8 WDA Staff .......................................................................................................10 Who to Contact ...............................................................................................12 Directions to the WDA Offices...........................................................................14 WDA Committees.............................................................................................16 Important Contact Information............................................................................18 Related Organizations.......................................................................................19 Dental Education ..............................................................................................20 InSession..........................................................................................................21 Member Benefits and Resources ........................................................................22 Mentor Program................................................................................................27 WDA Foundation..............................................................................................28 Mission of Mercy..............................................................................................29 Donated Dental Services....................................................................................30 Dentists Concerned for Dentists...........................................................................30 Relief Fund........................................................................................................30 Thank You, Advertisers ......................................................................................31 WDA Bylaws ...................................................................................................32 Code of Ethics .................................................................................................43 Antitrust Statement.............................................................................................49 WDA Political Action Team ...............................................................................50 WDA Legislative Day........................................................................................52 Contacting Your Legislators................................................................................53 Wisconsin Legislators........................................................................................54 Government Agencies ......................................................................................56 WDA Legislative Priorities..................................................................................57 Wisconsin Dental Practice Act ...........................................................................61 Continuing Education Requirements....................................................................63 Wisconsin Administrative Rules..........................................................................67 X-ray Regulations ..............................................................................................77 Frequently Asked Practice and Legal Questions...................................................80 Recommended Products, Programs and Services ................................................98 Professional Insurance Programs.......................................................................100 Member Directory Pyramid of Pride Awards ................................................................................101 POP nomination form....................................................................................102 Dentists Active Dentists ..............................................................................................103 Active Dentists by City ..................................................................................134 CE Cruise.....................................................................................................139 Dentists by Specialty......................................................................................140 Retired Dentists .............................................................................................142 Dental Hygienists Dental Hygienist Membership.......................................................................149 Active Dental Hygienists ...............................................................................150 ADA Center for Professional Success ...............................................................152 Past-Presidents Listing ......................................................................................153 Update Your WDA Directory Listing .................................................................154

WDA Sourcebook Conditions of Use The Wisconsin Dental Association Sourcebook (Member Directory & Practice Guide) is published annually as a member service. Membersâ&#x20AC;&#x2122; contact information is to be used only by WDA members and only for professional purposes or to communicate with colleagues. All commercial, promotional, solicitation and similar uses are prohibited. This information is not to be used to generate mailing, email, telephone or any other form of mass-contact or distribution list not specifically approved by the WDA. In addition to available legal remedies and other possible sanctions, improper use of WDA Sourcebook contents may result in an individual, dental practice or other organization being (i) denied access to the membership directory section of, or the ability to advertise in, future WDA Sourcebooks, (ii) denied access to or exhibitor privileges at the annual InSession conference and (iii) prevented from advertising in the WDA Journal or other WDA-related publications. We take the privacy of our 3,000-plus WDA members seriously and ask you to respect it as well. 096012-0001\11094792.1

2014 WDA Sourcebook

WDA Strategic Plan

Strategic Plan 2011-2014 Mission

The Wisconsin Dental Association advances the interests of its members and the dental profession by promoting professional excellence and quality oral health care for the public.

Goals

Serve its members Desired Outcome: WDA will provide programs and services that its members agree provide them with real value. Advocate for public-policy on oral health care Desired Outcome: WDA will be the advocate for quality oral health care in all public policy issues. Educate the public on oral health and delivery of care Desired Outcome: WDA will be recognized as the public’s authoritative source of oral health care information. Empower its members and staff for organizational and member success Desired Outcome: WDA will develop governance systems and business processes to empower its members, staff and partners for maximum organizational achievement and member effectiveness in WDA initiatives.

Guiding Principles & Beliefs The Wisconsin Dental Association believes . . . . 1. Oral health is essential to the quality of life and an integral component to overall health. 2. The strength of the dental profession is directly linked to the improvement of the public’s oral health. 3. The integrity of the patient-doctor relationship is critical to positive health outcomes. 4. Oral health care must be based on scientific principles and clinical judgment. 5. Professional diagnosis, education, restoration and on-going prevention are the cornerstones of oral health care. 6. Oral health care is best provided by a coordinated team led by the dentist. 7. A properly educated and adequately sized work force is critical to the delivery of quality oral health care. 8. Strong support of excellence in dental education and lifelong learning is critical to the future of the profession. 9. The ADA Principles of Ethics and Code of Professional Conduct are the hallmarks of professionalism in dentistry to which all Wisconsin dentists should abide.

2014 WDA Sourcebook

10. WDA membership is a foundation of a successful practitioner. 11. Strong, stable membership is critical to the Association’s effectiveness. 12. The tripartite organization relationship is vital to the WDA’s ability to achieve its goals. 13. An inclusive environment that values and embraces membership diversity is essential. 14. Access to leadership positions should be open to all members in accordance with their talents and interests. 15. Timely, valuable services to its members are essential to the association’s success and the success of its members. 16. Enhanced, targeted communications from WDA to its members will be compelling, fast, and easily accessible. 17. The Association must attract, employ, retain and recognize skillful and dedicated staff. 18. A research and development culture with a high tolerance for missteps and unanticipated or failed outcomes when exploring endeavors is fostered to encourage development of new member programs, products and services.

Your Find A Dentist profile... as good as YOU make it! More and more people are expected to be searching online for a WDA member dentist thanks to the Own Your Smile oral health literacy, public awareness campaign that kicked-off in January 2014. Give prospective and current patients access to the most current information about you and your practice by updating your FREE member profile in the American Dental Association’s Find A Dentist online directory. To get started, follow these simple steps:

• Watch Dr. Carl Meyers (West Bend) demonstrate how to update your profile in a WDA-TV video. • Visit ADA.org/memberprofile and log in. Find A Dentist is used by an estimated 20,000 people a month nationwide to choose a dental home and by member dentists wanting to make a referral or connect with a colleague. They see: • Your photo • Your office address with map • Office hours • Office contact information • Links to practice website, social media channels • Education and specialty • Languages spoken • Years in practice • If your practice accepts insurance • Types of payment accepted • Your affiliations with any of the nine ADA-recognized specialties Information is published on ADA.org in the Member Directory and through the Find A Dentist search on ADA’s MouthHealthy.org public/patient website. Find A Dentist is a FREE member service that is easy to use and can help build your practice. Update your profile today! 2014 WDA Sourcebook

Regions and Components

DOUGLAS

BAYFIELD

IRON ASHLAND

BURNETT

WASHBURN

VILAS

SAWYER

FLORENCE ONEIDA

PRICE

FOREST

POLK

MARINETTE

RUSK

BARRON

LINCOLN LANGLADE

TAYLOR CHIPPEWA

ST. CROIX

MENOMINEE*

DUNN

DOOR

OCONTO

MARATHON PIERCE

SHAWANO

CLARK

EAU CLAIRE

TREMP

BUFFALO

EALEA U

PORTAGE PEPIN

WAUPACA OUTAGAMIE BROWN

WOOD

KEWAUNEE

JACKSON ADAMS

LACROSSE

WAUSHARA

MANITOWOC

WINNEBAGO CALUMET

MONROE MARQUETTE

JUNEAU

GREEN LAKE

FOND DU LAC

SHEBOYGAN

COLUMBIA

DODGE

SAUK

RICHLAND

OZAUKEE

W AS

CRAWFORD

TO N

VERNON

DANE IOWA

JEFFERSON

WAUKESHA

MILWAUKEE

GRANT RACINE LAFAYETTE

REGION 1 - NORTHWEST

Central Wisconsin Dental Society: Clark, Florence, Forest, Langlade, Lincoln, Marathon,Oneida, Portage, Price, Taylor, Vilas and Wood counties Northern Wisconsin Dental Society: Ashland, Bayfield, Douglas and Iron counties Northwest District Dental Society: Barron, Burnett, Chippewa, Dunn, Eau Claire, Pierce, Polk, Rusk, Sawyer, St. Croix and Washburn counties

REGION 2 - NORTHEAST

Brown Door Kewaunee Dental Society: Brown, Door, Kewaunee counties Fond du Lac County Dental Society: Fond du Lac County Manitowoc Calumet County Dental Society: Calumet and Manitowoc counties Marinette Oconto County Dental Society: Marinette and Oconto counties Outagamie County Dental Society: Outagamie County Shawano County Dental Society: Shawano County Sheboygan County Dental Society: Sheboygan County Waupaca County Dental Society: Waupaca County Winnebago County Dental Society: Green Lake, Waushara and Winnebago counties

REGION 3 - GREATER MILWAUKEE

Greater Milwaukee Dental Association: Milwaukee County

2014 WDA Sourcebook

GREEN

ROCK

WALWORTH

KENOSHA

REGION 4 - SOUTHEAST

Burlington Dental Society: Walworth County Kenosha County Dental Society: Kenosha County Racine County Dental Society: Racine County Rock County Dental Society: Rock County Washington Ozaukee County Dental Society: Ozaukee and Washington counties Waukesha County Dental Society: Waukesha County

REGION 5 - SOUTHWEST

Columbia Dodge Marquette County Dental Society: Columbia, Dodge and Marquette counties Greater Dane Dental Society: Dane and Green Counties Jefferson County Dental Society: Jefferson County La Crosse District Dental Society: La Crosse, Monroe and Vernon counties Sauk Juneau Adams County Dental Society: Adams, Juneau and Sauk counties Southwestern District Dental Society: Crawford, Iowa, Grant, Lafayette and Richland counties Tri-County Dental Society: Buffalo, Jackson, Pepin and Trempealeau counties

REGION 6 - STUDENT REGION

Marquette University School of Dentistry American Student Dental Association Chapter *Menominee Indian Reservation

Officers and Trustees

WDA Officers

Dr. Paul Levine President-Elect Milwaukee plevine@wda.org

Dr. Ryan Braden Vice President Lake Geneva rbraden@wda.org

Dr. Timothy Durtsche Past-President La Crosse tdurtsche@wda.org

Dr. John R. Moser Treasurer Milwaukee jmoser@wda.org Terms of Officers &

Officers and Trustees

Dr. Julio Rodriguez President Brodhead jrodriguez@wda.org

Trustees Nov. 2013 Nov. 2014 Mr. Mark Paget Executive Director/Secretary West Allis mpaget@wda.org

Dr. Richard Lofthouse Speaker of the House of Delegates Fennimore rloft1@tds.net

Dr. Gary Jeffers 9th District ADA Trustee Northville, Mich. jeffersg@ada.org

Dr. David Kenyon Region 1 Altoona dkenyon@wda.org

Dr. Jeffrey Nehring Region 1 Mercer jnehring@wda.org

Dr. Jennifer Peglow Region 1 Stevens Point jpeglow@wda.org

Dr. Paul Feit Region 2 Sturgeon Bay pfeit@wda.org

Dr. Peter Hehli Region 2 Appleton phehli@newbc.rr.com

Dr. Jeffrey Kraig Region 2 Fond du Lac jkraig@wda.org

Dr. Lynn Lepak-McSorley Region 3 Milwaukee llepak-mcsorley@wda.org

Dr. Thomas Kielma Region 3 Milwaukee tkielma@wda.org

Dr. Thomas Raimann Region 3 Hales Corners traimann@wda.org

Dr. Edward Chiera Region 4 Beloit echiera@wda.org

Dr. Robert Brennan Editor Neenah rbrennan@wda.org

WDA Trustees

Dr. Cliff Hartmann Region 4 New Berlin chartmann@wda.org

Dr. Ned Murphy Region 4 Racine n_murphy@ameritech.net

Dr. L. Stanley Brysh Region 5 Madison lbrysh@meriter.com

Dr. David Clemens Region 5 Wisconsin Dells dclemens@wda.org

Dr. Patrick Tepe Region 5 Middleton ptepe@wda.org

Ms. Rosa Barnes Region 6 Marquette University School of Dentistry rbarnes@wda.org 2014 WDA Sourcebook

Component Officers

PLEASE NOTE: Component officers change throughout

the year. For the most current officer information, visit the Local Dental Societies section on WDA.org.

Brown Door Kewaunee Dental Society Trustee Liaison: Dr. Paul Feit Dr. Lee Bialkowski, President............... 920-336-2299 Dr. Stephen Lasslo, Vice President....... 920-532-0091 Dr. Courtney Anderson, Secretary....... 920-347-0400 Burlington Dental Society Trustee Liaison: Dr. Ed Chiera Dr. Chad Greving, President............... 262-723-2900 Dr. Bryan Van Oven, Vice President.... 262-763-8101 Dr. Rebecca Greving, Secretary.......... 262-723-2900 Dr. Mark Braden, Treasurer................ 262-248-0120 Central Wisconsin Dental Society Trustee Liaison: Dr. Jennifer Peglow Dr. Rick Mueller, President ................. 715-387-1702 Dr. William Horton, Vice President ..... 715-387-1702 Columbia Dodge Marquette County Dental Society Trustee Liaison: Dr. Dave Clemens Dr. Jared Homan, President ............... 920-324-4218 Dr. Ross Werner, Treasurer ................ 920-326-3191 Fond du Lac County Dental Society Trustee Liaison: Dr. Jeff Kraig Dr. William Mauthe III, President......... 920-921-1244 Dr. Tim Harper, Secretary/Treasurer.... 920-922-7720 Greater Dane Dental Society Trustee Liaison: Dr. Stan Brysh Dr. Thomas Reid, President................. 608-222-8344 Dr. Michael Kokott, Vice President ...... 608-848-4000 Dr. Tamim Sifri, Secretary .................. 608-241-8782 Dr. Benjamin Farrow, Treasurer........... 608-204-0222 www.danecountydental.com Greater Milwaukee Dental Association Trustee Liaisons: Drs. Tom Kielma, Lynn Lepak-McSorley and Tom Raimann Dr. Lynn Lepak-McSorley, President...... 414-383-8787 Dr. Russell Dunkel, President-Elect........ 414-427-8565 Dr. Michael Grady, Vice President....... 414-288-0788 Dr. Richard Mueller, Treasurer............. 414-425-1510 Dr. Charles Lenarduzzi, Secretary....... 414-771-2345 www.gmda.org

2014 WDA Sourcebook

Jefferson County Dental Society Trustee Liaison: Dr. Stan Brysh Dr. Jennifer Stafford, President ........... 920-563-7323 Dr. Brenda Garrison, Vice President.... 920-563-9373 Dr. Philip Grosnick, Secretary/Treasurer ............................................................ 920-261-2828 Dr. Leslie Showalter, Membership Chair.... 920-563-4415 Kenosha County Dental Society Trustee Liaison: Dr. Ned Murphy Dr. Bryon Kozak, President ................ 262-697-8766 Dr. Laura Guttormsen, President-Elect... 262-654-0267 Dr. Jane Wright, Vice President........... 262-694-5272 Dr. Cody Nelson, Secretary................ 262-652-7668 Dr. James Fulmer, Treasurer................ 262-657-5408 La Crosse District Dental Society Trustee Liaison: Dr. Dave Clemens Dr. Erica Stanek, President.................. 608-782-5675 Dr. Dan Kujak, Vice President............. 608-784-4063 Dr. Ellyn English, Secretary/Treasurer..... 608-775-2696 Manitowoc Calumet County Dental Society Trustee Liaison: Dr. Pete Hehli Dr. Matthew Culligan, President.......... 920-682-0321 Dr. Ronald Egan, Vice President.......... 920-684-8033 Dr. Abbie Kershner, Secretary/Treasurer... 920-683-2101 Dr. Thomas Peterson, Membership Chair ............................................................ 920-775-4531 Marinette Oconto County Dental Society Trustee Liaison: Dr. Paul Feit Dr. John Magnin, President ................ 715-735-3337 Dr. Justin Oberdorfer, Secretary/Treasurer ........................................................... 715-735-3337 Northern Wisconsin Dental Society Trustee Liaison: Dr. Jeff Nehring Dr. John Conkright, President ............. 715-392-4545 Dr. Kimberly Hyopponen, Vice President....715-682-6675 Dr. Jon Nelson, Secretary/Treasurer/Membership ....................................................... 715-398-3239 Northwest District Dental Society Trustee Liaison: Dr. Dave Kenyon Dr. Terrance Miskulin, President........... 715-965-5396 Dr. Jason Johnson, Treasurer............... 715-832-5396 Dr. Matt Larson, Secretary..................... 715-514-3333 Outagamie County Dental Society Trustee Liaison: Dr. Pete Hehli Dr. Thomas Lornson, President............ 920-984-3315 Dr. Jolanta Pajek, President-Elect......... 920-993-8682 Dr. Edward Polzin, Secretary/Treasurer... 920-733-8129

Component Officers

Rock County Dental Society Trustee Liaison: Dr. Ed Chiera Dr. Brian Pelsue, President.................. 608-754-4998 Dr. Lloyd Smith, Secretary/Treasurer ..... 608-752-6848 Sauk Juneau Adams County Dental Society Trustee Liaison: Dr. Dave Clemens Dr. Jeremy Gross, President ............... 608-254-2345 Dr. Bradley Bjorklund, President-Elect... 608-356-6611 Dr. Amanda Ganshert, Treasurer/Membership Chair ....................................................... 608-356-3790 Dr. Ashley Sorenson, Secretary........... 608-524-4213

Waukesha County Dental Society Trustee Liaison: Dr. Cliff Hartmann Dr. Joseph Best, President .................. 262-547-8665 Dr. Todd Rasch, President-Elect............ 262-956-6000 Dr. Bernhard Bayer, Vice President/Treasurer ....................................................... 262-542-2293 Waupaca County Dental Society Trustee Liaison: Dr. Jeff Kraig Dr. Karen Johnson, President/Treasurer......715-823-2233 Dr. Stephen Saunders, Secretary............ 715-258-3035 Winnebago County Dental Association Trustee Liaison: Dr. Jeff Kraig Dr. Jeffrey Keesler, President............... 920-729-0889 Dr. Michelle Wihlm, President-Elect...... 920-231-0060 Dr. Shaheda Govani, Vice President ..... 920-231-1955 Dr. Tyler Brown, Secretary/Treasurer... 920-725-0400 Dr. David Mentz, Membership Chair... 920-722-0530

Component Officers

Racine County Dental Society Trustee Liaison: Dr. Ned Murhpy Dr. Debra Palmer, President ............... 262-554-9055 Dr. Ned Murphy, Secretary ............... 262-886-9440 Dr. James Luetzow, Treasurer.............. 262-554-5468 Dr. Nicolet De Rose, Membership Chair ....................................................... 262-634-8662

Shawano County Dental Society Trustee Liaison: Dr. Paul Feit Dr. Anton Piantek, President............... 715-524-2127 Dr. William Swetlik, Secretary............ 715-526-2544 Sheboygan County Dental Society Trustee Liaison: Dr. Pete Hehli Dr. William Guzzetta,President ......... 920-564-2925 Dr. Andrea Igowsky, President-Elect .... 920-452-7336 Dr. Matt Bistan, Treasurer................... 920-457-2255 Dr. Jaime Marchi, Secretary .............. 920-452-7336 Dr. Andrea Igowsky, Membership Chair .. 920-452-7336 Southwestern District Dental Society Trustee Liaison: Dr. Pat Tepe Dr. Terrence Moen, President.............. 608-647-3222 Dr. Matthew Andrews, Vice President.... 608-744-2111 Dr. Thomas Williams, Treasurer .......... 608-647-3993 Tri-County Dental Society Trustee Liaison: Dr. Dave Clemens Dr. Jeffrey Matthews, President .............. 715-538-1800 Dr. Rachel Steele, Vice President............. 715-284-9409 Dr. Jeremy Vogel, Secretary/ Treasurer......715-926-4459

Visit WDA.org for upcoming component meetings and events.

Washington Ozaukee County Dental Society Trustee Liaison: Dr. Cliff Hartmann Dr. Kelly West, President ................... 262-377-2668 Dr. Jeffrey Burke, President-Elect ......... 262-240-9840 Dr. Christopher Shumway, Treasurer.... 262-644-7400 2014 WDA Sourcebook

WDA Staff

Executive Office 414-276-4520 or 800-364-7646 â&#x20AC;˘ info@wda.org Mark Paget Executive Director

Communications and Marketing Carol S. Weber, APR Director of Communications and Marketing

mpaget@wda.org 414-755-4100 (direct phone) 414-755-4101 (direct fax)

cweber@wda.org 414-755-4108 (direct phone) 414-755-4109 (direct fax)

Lisa Chandre Executive Assistant

lchandre@wda.org 414-755-4104 (direct phone) 414-755-4105 (direct fax)

Amanda Brezgel Electronic Communications Coordinator abrezgel@wda.org 414-755-4112 (direct phone) 414-755-4113 (direct fax)

Membership Lani Becker, CAE Director of Membership, Meetings and Strategic Initiatives Associate Executive Director

Emily Bultman, CDE Communications Coordinator and WDA Journal Managing Editor ebultman@wda.org 414-755-4110 (direct phone) 414-755-4111 (direct fax)

lbecker@wda.org 414-755-4114 (direct phone) 414-755-4115 (direct fax)

Kristine Anderson Mediation Services Coordinator kanderson@wda.org 414-755-4120 (direct phone) 414-755-4121 (direct fax)

Susan John Membership Services Representative sjohn@wda.org 414-755-4118 (direct phone) 414-755-4119 (direct fax)

Christine Peacy Membership Services Representative cpeacy@wda.org 414-755-4116 (direct phone) 414-755-4117 (direct fax)

Betsy Krekling Member Relations Coordinator bkrekling@wda.org 414-755-4126 (direct phone) 414-755-4127 (direct fax)

2014 WDA Sourcebook

Accounting Kelly Sics, CPA Director of Finance

ksics@wda.org 414-755-4102 (direct phone) 414-755-4103 (direct fax)

Abby Van Kerkvoorde Accounting Manager avankerkvoorde@wda.org 414-755-4124 (direct phone) 414-755-4125 (direct fax) Anne Hart Accounts Receivable Coordinator ahart@wda.org 414-755-4164 (direct phone) 414-755-4165 (direct fax)

Shelia McIntyre Accounts Payable Coordinator smcintyre@wda.org 414-755-4106 (direct phone) 414-755-4107 (direct fax)

WDA Staff Lisa Schubring Accountant

lschubring@wda.org 414-755-4162 (direct phone) 414-755-4163 (direct fax)

Mara Brooks Director of Government Services mbrooks@wda.org 414-755-4130 (direct phone) 414-755-4131 (direct fax)

Vicki Bohman Executive Director

vbohman@wda.org 414-755-4198 (direct phone) 414-755-4199 (direct fax)

WDA Insurance & Services Corp.

WDA Staff

Legislative Office 608-250-3442 or 888-538-8932

WDA Foundation â&#x20AC;˘ 800-364-7646

Professional Insurance Programs 414-277-0154 or 800-637-4676

Dana Ponce Government Services Assistant dponce@wda.org 414-755-4134 (direct phone) 414-755-4135 (direct fax)

Erika Valadez Dental Practice and Government Relations Associate evaladez@wda.org 414-755-4132 (direct phone) 414-755-4133 (direct fax)

info@insuranceformembers.net

The Dental Record

414-276-3954 or 800-243-4785 info@dentalrecord.com

Mara T. Roberts, CLU, RHU, REBC President

mroberts@insuranceformembers.net

414-755-4170 (direct phone) 414-277-1124 (direct fax) Ahdea Jarvis Director of Sales

WDA staff work for and to serve you in this member-driven organization. The 18 individuals in the West Allis executive and Madison legislative offices combined bring more than 300 years of professional experience to work each day on behalf of WDA dentists and dental hygienists.

ajarvis@insuranceformembers.net

See Who to Contact on pages 12-13 for more information.

Lisa Koss, MSC Director of Marketing

414-755-4174 (direct phone)

lkoss@insuranceformembers.net

414- 755-4160 (direct phone)

Donated Dental Services Carol Shoemaker DDS Director

cshoemaker@wda.org Southern and eastern Wisconsin (Calumet, Dodge, Door, Fond du Lac, Grant, Green, Jefferson, Kenosha, Kewaunee, LaFayette, Manitowoc, Milwaukee, Ozaukee, Racine, Rock, Sheboygan, Walworth, Washington, Waukesha and Winnebago counties) 888-338-6852 (toll-free) 414-755-4188 (direct phone) 414-276-8431 (fax)

Carrie Golabowski DDS Coordinator cgolabowski@wda.org Central and northern Wisconsin 866-812-9840 (toll-free) 414-755-4190 (direct phone) 414-276-8431 (fax)

Nancy Wuenne Property and Casualty Division Manager nwuenne@insuranceformembers.net

414-755-4180 (direct phone)

Brett Lindstrom Director of Professional Services blindstrom@wda.org

414-755-4082 (direct phone) 414-276-2186 (direct fax)

2014 WDA Sourcebook

Who to Contact

West Allis Executive Office: 414-276-4520 or 800-364-7646; info@wda.org Madison Legislative Office: 608-250-3442 or 888-538-8932 Accounting Anne Hart, x4164 or ahart@wda.org

Career days Betsy, x4126 or bkrekling@wda.org

Address/email updates (new, changes) Christine, x4116 or cpeacy@wda.org

CareerConnection (online job board) Betsy, x4126 or bkrekling@wda.org

Advertising (WDA Journal, WDA Sourcebook and WDA.org) Emily, x4110 or ebultman@wda.org and Amanda x4112 or abrezgel@wda.org

Charging interest Erika, 888-538-8932 or evaladez@wda.org

Amalgam recycling Erika, 888-538-8932 or evaladez@wda.org

Classifieds Emily, x4110 or ebultman@wda.org

Annual session/InSession Susan, x4118 or sjohn@wda.org, Lani x4114 or lbecker@wda.org

Classroom presentations Emily, x4110 or ebultman@wda.org

Antitrust Mark, x4100 or mpaget@wda.org Assignment of benefits Erika, 888-538-8932 or evaladez@wda.org Associate membership Christine, x4116 or cpeacy@wda.org Board of Trustees Mark, x4100 or mpaget@wda.org Bylaws (WDA and ADA) Lani, x4114 or lbecker@wda.org Calendar of events (continuing education) Emily, x4110 or ebultman@wda.org and Amanda, x4112 or abrezgel@wda.org

2014 WDA Sourcebook

Charitable dental care Carol, x4108 or cweber@wda.org

Code of Ethics (WDA and ADA) Kris, x4120 or kanderson@wda.org

Delegation of duties (hygienists and assistants) Mara, 888-538-8932 or mbrooks@wda.org Dental assisting and hygiene programs Erika, 888-538-8932 or evaladez@wda.org Dental home Carol, x4108 or cweber@wda.org Dental hygiene membership Betsy, x4126 or bkrekling@wda.org Dental Practice Act Mara, 888-538-8932 or mbrooks@wda.org Dentistry Examining Board Mara, 888-538-8932 or mbrooks@wda.org Dentists Concerned for Dentists Susan, x4114 or sjohn@wda.org

Codes and claim questions Erika, 888-538-8932 or evaladez@wda.org

Direct Giver Program Dana, 888-538-8932 or dponce@wda.org

Community water fluoridation Erika, x4110 or evaladez@wda.org

Discounted office supplies (AMO) Susan, x4118 or sjohn@wda.org

Component dues payments Christine, x4116 or cpeacy@wda.org

Donated Dental Services See page 30

Component meetings and rosters Betsy, x4126 or bkrekling@wda.org Continuing education regulations Mara, 888-538-8932 or mbrooks@wda.org Contract analysis Erika, 888-538-8932 or evaladez@wda.org

Dues Christine, x4116 or cpeacy@wda.org Dues payment processing Anne, x4164 or ahart@wda.org Endorsed products and services See pages 100 and 101 Executive Directorâ&#x20AC;&#x2122;s Update Amanda, x4112 or abrezgel@wda.org

Who to Contact Membership Susan, x4118 or sjohn@wda.org

Relief Fund Betsy, x4126 or bkrekling@wda.org

Give Kids A Smile® Emily, x4110 or ebultman@wda.org

Membership status reclassification Susan, x4118 or sjohn@wda.org

Scholarships – Foundation Vicki, x4198 or vbohman@wda.org

Grants – Foundation Vicki, x4198 or vbohman@wda.org

Mediation Services Kris, x4120 or kanderson@wda.org

Sedation regulations Mara, 888-538-8932 or mbrooks@wda.org

HIPAA Erika, 888-538-8932 or evaladez@wda.org

Mentor Program Susan, x4118 or sjohn@wda.org

Social media Amanda, x4112 or abrezgel@wda.org

House of Delegates (WDA and ADA) Lisa, x4104 or lchandre@wda.org

Mission of Mercy Lani, x4114 or lbecker@wda.org

Starting your practice guide Susan, x4118 or sjohn@wda.org

National Children’s Dental Health Month Emily, x4110 or ebultman@wda.org

Two Cents for Tooth Sense Mara, 888-538-8932 or mbrooks@wda.org; Carol, x4108 or cweber@wda.org

OralLongevityTM Carol, x4108 or cweber@wda.org

WDA Foundation Vicki, x4198 or vbohman@wda.org

OSHA Erika, 888-538-8932 or evaladez@wda.org

WDA Hot Issues Carol, x4108 or cweber@wda.org

Own Your Smile Carol, x4108 or cweber@wda.org

WDA Journal/WDA Sourcebook Emily, x4110 or ebultman@wda.org

Patient education materials (brochures) See page 23

WDA website (www.wda.org) Amanda, x4112 or abrezgel@wda.org

Posters (OSHA, state and federal) Erika, 888-538-8932 or evaladez@wda.org

Wisconsin Dental Political Action Committee (WIDPAC) Dana, 888-538-8932 or dponce@wda.org

Public awareness Carol, x4108 or cweber@wda.org

Wisconsin statutes/rules Mara, 888-538-8932 or mbrooks@wda.org

Professional Insurance Programs See page 102

Workforce Erika, 888-538-8932 or evaladez@wda.org and Mara, 888-538-8932 or mbrooks@wda.org

Infection control and waste disposal Erika, 888-538-8932 or evaladez@wda.org Insurance (capitation, complaint resolution, coordination of benefits and TMD) Erika, 888-538-8932 or evaladez@wda.org Labels and listings Christine, x4116 or cpeacy@wda.org Legislation/legislators Mara, 888-538-8932 or mbrooks@wda.org Legislative Day Dana, 888-538-8932 or dponce@wda.org Licensure and regulation Mara, 888-538-8932 or mbrooks@wda.org Lobbying and lobby law Mara, 888-538-8932 or mbrooks@wda.org Media relations Carol, x4108 or cweber@wda.org Medicaid/BadgerCare Erika, 888-538-8932 or evaladez@wda.org

Public speaking support (spokesperson) Carol, x4108 or cweber@wda.org

Who to Contact

Forensic identification Kris, x4120 or kanderson@wda.org

Pyramids of Pride Betsy, x4126 or bkrekling@wda.org 2014 WDA Sourcebook

Directions to the WDA

Directions to the WDA Executive Office in West Allis 6737 W. Washington St., Ste. 2360 West Allis, WI 53214 Phone: 414-276-4520 or 800-364-7646 Fax: 414-276-8431 or 800-864-2997 info@wda.org I-94 to the 68th/70th Street Exit Turn South on 70th Street Turn East on Washington Street Summit Place will be one block down on the right. WDA suite is in building two on the third floor. Surface lot parking is available.

Directions to the WDA Legislative Office in Madison (New address effective May 1, 2014) 122 W. Washington Ave., Ste. 600 Madison, WI 53703 Phone: 608-250-3442 or 888-538-8932 Fax: 608-282-7716 or 888-822-2932 From the South and the East: • Highway 94 West to Madison or Highway 39/90 West to Madison • Exit Highway 30 W • Exit E. Washington Avenue (Hwy 151 S) toward the State Capitol • Turn right on N. Webster St. • Slight left on E. Dayton St., continue on to W. Dayton St. o State Street public parking ramp on right/ N. Carroll St. • No guest parking located at 122 W. Washington building • Follow W. Dayton St. and continue onto N. Fairchild St. • Turn left onto W. Washington Avenue (building in on the left) Use the 122 W. Washington Ave entrance and elevators From the North: • Highway 90/94 East to Madison • Exit Highway 51 S (Stoughton Rd.) • Turn right onto East Washington Ave. (Hwy 151 South) continue four miles toward State Capitol • Turn right on N. Webster St. • Slight left on E. Dayton St., continue on to W. Dayton St. o State Street public parking ramp on right/ N. Carroll St. • No guest parking located at 122 W. Washington building • Follow W. Dayton St. and continue onto N. Fairchild St. • Turn left onto W. Washington Avenue (building in on the left) Use the 122 W. Washington Ave entrance and elevators From the Southwest: • Highway 12, 14, 18 or 151 to Madison • Take Highway 12 East (Beltline East) • Exit #263 John Nolen Dr. • Turn left onto S. Broom St., continue onto N. Broom St. • Turn right onto W. Johnson St. • Turn right onto N. Carroll St. o State Street public parking ramp on right, N. Carroll/W. Dayton St. • No guest parking located at 122 W. Washington building • Turn right on W. Dayton St. and continue onto N. Fairchild St. • Turn left onto W. Washington Avenue (building in on the left) Use the 122 W. Washington Ave entrance and elevators

2014 WDA Sourcebook

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WDA Committees 2014 WDA COMMITTEE ROSTER (As of March 14, 2014)

WDA Committees

* All officers are ex-officio members of WDA committees and are not listed below.

ADA House Delegates (annual) Dr. Paul Levine, President-Elect, Chair Dr. Julio Rodriguez, President Dr. Ryan Braden, Vice President Dr. Dave Kenyon, Region 1 Dr. Jeff Kraig, Region 2 Dr. Monica Hebl, Region 3 Dr. Ned Murphy, Region 4 Dr. L. Stanley Brysh, Region 5 Dr. John R. Moser, Region 3 Staff liaison: Mark Paget, 800-364-7646 x4100 ADA House Alternate Delegates (annual) Dean William Lobb, MUSOD Dr. Paula Crum, Region 1 Dr. Robert Brennan, Region 2 Dr. Thomas Kielma, Region 3 Dr. Thomas Raimann, Region 3 Dr. Edward Chiera, Region 4 Dr. H. Michael Kaske, Region 4 Dr. Patrick Tepe, Region 5 Staff liaison: Mark Paget, 800-364-7646 x4100 Annual Session Committee (3 yr) Dr. Fred Jaeger, Chair (’15) Dr. Richard Bailey (’14) Dr. Pete Hehli (Board Liaison) Dr. Mary Hovel (’15) Dr. Geoff Mykelby (‘16) Dr. Jon Nelson (’16) Dr. Samantha Ruiz (’16) Ms. Carol Trecek (MUSOD) Staff liaisons: Lani Becker, 800-364-7646 x4114, Susan John, 800-364-7646 x4118 Bylaws Committee (5 yr) Dr. Henry Wengelewski, Chair (’17) Dr. Allison Dowd (’15) Dr. Mary Karkow (’18) Dr. Charles Lenarduzzi (’14) Dr. Leslee Timm (’16) Staff liaison: Lani Becker, 800-364-7646 x4114 Dental Benefit Plans Committee (3 yr) Dr. Russ Christian, Chair (’14) Dr. Stephen Waite, Vice Chair (’14) Dr. Susan Cable (’14) Dr. Todd Connell (’14) Dr. Kaveh Ghaboussi (’15) Dr. Daryl Holdredge (’15) Dr. David Mentz (’15) Dr. Greg Rodenbeck (’14) Dr. Tom Shaw (’14) Dr. John Masak (’15) Dr. David Kenyon (Board Liaison) Staff liaison: Erika Valadez, 888-538-8932

2014 WDA Sourcebook

Editorial Advisory Board (annual) Dr. Robert Brennan, Region 2, Editor Dr. Robert Darling, Region 2 Dr. Ellyn English, Region 1 Dr. Glenn Gequillana, Region 3 Dr. Gene Shoemaker, Region 4 Staff liaison: Emily Bultman, 800-364-7646 x4110 Ethics and Dental Relations Committee (3 yr) Dr. Martin Williams, Region 2, Chair (‘16) Dr. Dennis Abere, Region 3 (’16) Dr. Russell Dunkel, Region 3 (’16) Dr. Julie Fox, Region 1 (’16) Dr. Cynthia Jarzembinski, Region 4 (’14) Dr. Tamim Sifri, Region 5 (’15) Dr. Paula Crum, Region 1 (’15) At Large Dr. Shaheda Govani, Region 2 (’15) At Large Dr. Leonardo Huck, Region 4 (’16) At Large Consultant: Kris Anderson, 800-364-7646 x4120 Executive Committee (annual) Dr. Julio Rodriguez, President, Chair Dr. Paul Levine, President-Elect, Vice Chair Dr. Ryan Braden, Vice President Dr. John R. Moser, Treasurer Dr. Timothy Durtsche, Immediate Past-President Dr. David Kenyon, Region 1 Dr. Paul Feit, Region 2 Dr. Thomas Kielma, Region 3 Dr. Ned Murphy, Region 4 Dr. L. Stanley Brysh, Region 5 Mr. Mark Paget, Executive Director Staff liaison: Mark Paget, 800-364-7646 x4100 Finance Committee (annual) Dr. John R. Moser, Treasurer, Chair Dr. Paul Levine, President-Elect, Co-Vice Chair Dr. Jeffrey Kraig, Region 2, Co-Vice Chair Dr. Jeff Nehring, Region 1 Dr. Thomas Raimann, Region 3 Dr. Clifford Hartmann, Region 4 Dr. David Clemens, Region 5 Dr. Julio Rodriguez, President Dr. Ryan Braden, Vice President Dr. Timothy Durtsche, Immediate Past-President Staff liaison: Kelly Sics, 800-364-7646 x4102 House Nominating Committee (annual) Dr. Martin Williams, Region 2, Chair Dr. Rick Mueller, Region 1 Dr. Russ Dunkel, Region 3 Dr. John Onderak, Region 4 Dr. Randy Ballweg, Region 5 Staff liaison: Mark Paget, 800-364-7646 x4100 House Nominating Committee Alternates (annual) Dr. Nick Christianson, Region 1 Dr. Paula Crum, Region 2 Dr. Mike Grady, Region 3 Dr. H. Michael Kaske, Region 4 Dr. Tamim Sifri, Region 5 Staff liaison: Mark Paget, 800-364-7646 x4100

Legislative Advocacy Committee (4 yr) Dr. Eric teDuits, Chair (’14) Dr. Ed Chiera, Vice Chair (’17) Dr. Joseph Best (’14) Dr. Russell Christian (’14) Dr. Brett Clark (‘16) Dr. Dave Clemens (’15) Dr. Timothy Cooper (’16) Dr. Eva Dahl (’16) Dr. Nicolet De Rose (’15) Dr. Dennis Engel (’14) Dr. Paul Hagemann (’17) Dr. Chris Hansen, WIDPAC Chair (’16) Dr. David Harry (’14) Dr. Monica Hebl (’17) Dr. Pete Hehli (Board Liaison) Dr. Jeremy Hoffman (’16) Dr. Fred Jaeger (’15) Dr. Christopher Johnson (’15) Dr. H. Michael Kaske (’14) Dr. David Kenyon (’14) Dr. Timothy Kinzel (’16) Dr. Jeff Moos (‘16) Dr. James Morgenroth (’14) Dr. John Mueller (’14) Dr. Mark Mueller (’14) Dr. Richard Mueller (’15) Dr. Ned Murphy (’14) Dr. Paul Nemcek (‘16) Dr. Jolanta Pajek (’15) Dr. Julio Rodriguez (’15) Dr. Matt Roggensack (‘15) Dr. Brett Skarr (’17) Dr. James Springborn (’17) Dr. Steven Stoll (‘17) Dr. Barrett Straub (‘17) Dean William Lobb (MUSOD) Mr. Andrew Welles (MUSOD Student) Staff liaison: Mara Brooks, 888-538-8932 Long Range Planning Committee (annual) Dr. Ryan Braden, Vice President, Chair Dr. Julio Rodriguez, President Dr. Paul Levine, President-Elect Dr. Timothy Durtsche, Immediate Past-President Dr. John R. Moser, Treasurer Dr. Robert Brennan, Editor Dr. Jennifer Peglow, Region 1 Dr. Peter Hehli, Region 2 Dr. Lynn Lepak-McSorley, Region 3 Dr. Edward Chiera, Region 4 Dr. Patrick Tepe, Region 5 Staff liaisons: Mark Paget, 800-364-7646 x4100 Lani Becker, 800-364-7646 x4114 Mediation Services Committee (none set) Dr. John R. Look, Chair Dr. Julie Fox Dr. Gregory P. Harvey Dr. Mary Hovel Dr. John Patrickus Dr. Paul R. Schulze Dr. Thomas F. Voelker Consultant: Kris Anderson, 800-364-7646 x4120

WDA Committees Public Relations Committee (3 yr) Dr. Carl Meyers, Region 4, Chair (’14) Dr. Thor Anderson, Region 5 (’15) Dr. Nicholas Christianson, Region 1 (’16) Dr. Ryan Dulde, Region 3 (’15) Dr. Mike Grady, Region 3 (’16) Dr. Megan Heitke, Region 3 (’14) Dr. Bill Horton, Region 1 (’14) Dr. Pat McConnell, Region 2 (’16) Dr. John Pinzl, Region 1 (’16) Ms. Beth Hettwer, RDH (’15) Dr. Robert Brennan, Editor Dr. Jeff Kraig (Board Liaison)

Public Relations Committee (cont.) Staff liaison: Carol Weber, 800-364-7646 x4108 Consultant: Rick Brandtjen, Group One Marketing

AFFILIATED GROUPS

Mission of Mercy Committee (cont.) Mr. Paul Batley Ms. Deb Beres, RDH Ms. Heidi Gaertner, RDH Ms. Nancy Kenyon Ms. Colleen Krueger, RDH Ms. Annie Maslowski, RDH Ms. Colleen Pittner Ms. Marissa Rodriguez Ms. Brenda Siren Ms. Linda Stoll Ms. Sena Toews Ms. Brenda Wiederholt Mr. Travis Zick, CDT Staff liaison: Lani Becker, 800-364-7646 x4114

WDA Foundation, Inc. – Donated Dental Services Dr. Paul Conrardy, Chair Dr. Kathleen Roth, Vice Chair Ms. Maryann Dillon, CAE, Secretary Dr. James Amstadt Dr. Lysette Brueggeman Dr. Jeffrey Chaffin, State Dental Director with Department of Health Services Dr. Julie Fox Dr. Scott Johnson Dr. Vijay Parmar Dr. Julio Rodriguez Mr. Richard Bong, Layton Dental Lab Mr. Dennis Brown, Delta Dental of WI Mr. Dennis McGuire Mr. Don Warden Program director: Carol Shoemaker, 888-338-6852 Carrie Golabowski, 866-812-9840

WDA Insurance and Services Corp. WDAISC Board (3yr) Dr. Jeff Kraig, Chair (’16) Dr. Ryan Braden, Vice Chair (’16) Mr. Mark Paget, Secretary Dr. Josephine Chianello-Berman, At Large (’15) Dr. Mark Crego, At Large (’15) Mr. Peter R. Bray, CPA, At Large (’14) Dr. John R. Moser, WDA Treasurer (’16) Ms. Mara Roberts, WDAISC President Dr. Patrick Tepe, WDA Trustee (’16) Ms. Kelly Sics, CPA (Board Liaison) Staff liaison: Kelly Sics, 800-364-7646 x4102

WDA FOUNDATION Dentists Concerned for Dentists (none set) Dr. James Markenson, Chair Dr. Bill Beaupre, Vice Chair Dr. Robert Cline Dr. William J. Franta Dr. Thomas Honl Dr. Ell L. Lee Dr. Ken Yarnell Staff liaison: Susan John, 800-364-7646 x4118 Mission of Mercy Committee (none set) Dr. Thomas Raimann, Chair Dr. Allison Dowd, Co-Vice Chair Dr. Lynn Lepak-McSorley, Co-Vice Chair Dr. Zach Graf, 2014 Local Chair Dr. Tammy Boudry Dr. Ryan Braden Dr. Mark Braden Dr. Michael Cahlamer Dr. Robert Darling Dr. Fred Eichmiller Dr. Kenneth Geiger Dr. William Lobb (MUSOD) Dr. James Morgenroth Dr. Jay Preston Dr. Laura Rammer Dr. Gene Shoemaker

Relief Committee (5 yr) Dr. Greg Killian, Chair (’14) Dr. Charles Nyberg, Vice Chair (’15) Dr. Lynne Brock (’17) Dr. London Cooper (’18) Dr. Kelly West (’16) Staff liaison: Betsy Krekling, 800-364-7646 x4126 WDA Foundation, Inc. Board (3 yr) Dr. Loren Swanson, President Dr. Christine Tempas, Treasurer Dr. Anthony Sciascia, Immediate PastPresident Mr. Mark Paget, Secretary Dr. Susan Cable, Region 4 (’15) Dr. Tim Cooper, Region 1 (’14) Dr. Francesca De Rose, Region 4 (’15) Dr. James Morgenroth, Region 3 (’15) Dr. Jack Sadowski, Region2 (’16) Dr. Peter Steinert, Region 2 (’14) Dr. James Van Miller, Region 2 (’16) Dr. Robb Warren, Region 5 (’14) Mr. Paul Batley, Henry Schein Dental (’16) Mr. Andy Lehmkuhl, Edge Advisors (’16) Ms. Jeanne Rude, Community Volunteer (’15) Mr. David C. Wagner, Schenck S.C. (’15) Mr. Tom Witkowski, Retired WDAISC President (’16) Dr. Roger Comeau (Emeritus) Dr. Ronald Stifter (Emeritus) Mr. Dennis McGuire (Emeritus) Staff liaison: Vicki Bohman, 800-364-7646 x4198

WDA Committees

Membership Committee (3 yr) Dr. Lysette Brueggeman, Chair (’14) Dr. Randal Valenta, Vice Chair (’16) Dr. Tip Brown (’14) Dr. Dan Kujak (’16) Dr. Tanner McKenna (’17) Dr. Laura Rammer (’15) Dr. Lisa Koenig (MUSOD) Dr. Lynn Lepak-McSorley, Board Liaison Dr. Gene Shoemaker, ADA Council Liaison (’15) Staff liaison: Betsy Krekling, 800-364-7646 x4126

Wisconsin Dental Political Action Committee (3 yr) Dr. Chris Hansen, Chair (’15) Dr. Pete Hehli, Vice Chair (’15) (Board Liaison) Dr. H. Michael Kaske, Secretary (’15) Dr. Timothy Cooper, Treasurer (‘14) Dr. Ed Chiera (’15) Dr. Davide Clemens (‘16) Dr. Eva Dahl (’16) Dr. Dennis Engel (’14) Dr. Paul Hagemann (’16) Dr. Monica Hebl (’14) Dr. Fred Jaeger (’15) Dr. Jeff Jones (’14) Dr. David Kenyon (’15) Dr. Mark Mueller (’14) Dr. Ned Murphy (’14) Dr. Matt Roggensack (’14) Dr. James Springborn (’14) Dr. Steven Stoll (‘16) Dr. Barrett Straub (’16) Dr. Eric teDuits (LC Chair) Staff liaison: Mara Brooks, 888-538-8932

2014 WDA Sourcebook

Important Contact Information

Important Contact Information Americans with Disabilities Act The American with Disabilities Act is a federal law that regulates how disabled patients and employees are treated. There are several guidelines to follow to make an office handicapped accessible. For more information and assistance on compliance, call the following: ADA legal affairs phone: 800-921-8099, ext. 2874 Department of Justice: 800-514-0301 Access board: 800-USA-ABLE (800-872-2253) Regional: 800-949-4ADA (800-949-4232) Better Business Bureau 10101 W. Greenfield Ave., Suite 125 Milwaukee, WI 53214 Inquiries phone: 414-847-6000 Complaints phone: 414-847-6000 General phone: 800-273-1002 Website: www.wisconsin.bbb.org CPR certification CPR Madison Phone: 608-772-5990 Website: www.cprmadison.com First Aid Plus Contact: David Myers Phone: 414-476-8054 Email: faptraining@aol.com Website: www.first-aidplus.com Fox Valley CPR Phone: 920-979-6161 Website: www.foxvalleycpr.com WDA Professional Services Phone: 800-243-4675 or 414-276-3954 Fax: 414-276-2186 Website: www.dentalrecord.com Wisconsin AIDS/HIV Program James Vergeront, M.D., Program Director Phone: 608-267-5287 Email: james.vergeront@wisconsin.gov Wisconsin Legislative Hotlines Phone: 800-362-9472 or 608- 266-9960 Website: www.legis.wisconsin.gov

2014 WDA Sourcebook

Tobacco Quit Line Phone: 800-QUIT-NOW (800-784-8669) Website: www.ctri.wisc.edu/ quitline2.html Wisconsin Aids 800-334-AIDS (800-334-2497) Insurance Professional Insurance Programs Phone: 800-242-9077 or 414-277-7727 Fax: 414-277-1124 Email: info@insuranceformembers.net Website: www.insuranceformembers.com Marquette University School of Dentistry Alumni relations Contact: Carol Trecek Phone: 414-288-5483 Email: carol.trecek@marquette.edu Clinic Contact: Dr. Richard Hagner, Chair Phone: 414- 288-6928 Email: richard.hagner@marquette.edu Deanâ&#x20AC;&#x2122;s office Contact: Dr. William Lobb Phone: 414-288-7485 Fax: 414-288-9586 Email: william.lobb@marquette.edu Practice placement Contact: Amanda Falkowski Phone: 414-288-3566 Email: amanda.falkowski@marquette.edu Temporary staffing Dental Express Staffing Contact: Erinn Brandau Phone: 608-343-6684 Email: bebranau@centurytel.net Website: www.dentalexpressstaffing.com Dental Word of Mouth Contact: Wendy Durfee, RDH Phone: 401-397-0519 Email: Wendy@DentalWordofMouth.com Website: www.dentalwordofmouth.com Mobile Medical Specialists Contact: Scott Stollenwerk Phone: 262-691-1000 Email: sstollenwerk@mobilemedicalspecialists.com Website: On Assignment Health Care Staffing Contact: Jamie Baumann Phone: 414-257-9513 Email: jamie.baumann@onassignment Website: www.onassignment.com

Redi Help Dental Contact: Tony Hains Phone: 414-727-7011 Email: tony@redihelp.net Website: www.redihelpdental.com Tripartite

800-621-8099 (members only) www.ada.org ADA (Washington, D.C.) Phone: 202-898-2400 ADA Business Resources Phone: 800-232-2308 Website: www.ada.org/ adabusinessresources.aspx ADA Center for Professional Success Website: www.success.ada.org/en/ ADA Catalog Sales Phone: 800-947-4746 Website: www.catalog.ada.org Great-West Life and Disability Insurance/ADA Phone: 800-568-2001 Website: www.insurance.ada.org Chicago Dental Society (Mid-Winter Meeting) Phone: 312-836-7300 Website: www.cdc.org Michigan Dental Association (ADA 9th District) Phone: 517-372-9070 Website: www.smilemichigan.com Minnesota Dental Association (Star of the North) Phone: 617-767-4252 Website: www.mndental.org

Important state and federal government agency information can be found on page 56.

Related Organizations

American College of Dentists – WI Section Dr. Nancy Larson 10562 N. Port Washington Road Phone: 262-240-1220 Email: nancylarson4213@sbcglobal.net American College of Prosthodontists – WI Section Dr. David Kachelmeyer 5800 N. Bayshore Dr. , #B-262 Milwaukee, WI 53217 Phone: 414-332-7450 Email: david.kachelmeyer@mu.edu American Dental Association 211 E. Chicago Ave. Chicago, IL 60611 Phone: 312-440-2500 or 800-621-8099 (members only) Fax: 312-440-7494 Website: www.ada.org American Dental Association 9th District Trustee Dr. Gary Jeffers University of Detroit Mercy School of Dentistry 2700 Martin Luther King Jr. Blvd Detroit, MI 48208 Phone: 313-494-6678 Fax: 313-494-6666 Email: jeffersg@ada.org Dental Forum Dr. Tim McNamara, President 8405 W. Forest Home Ave., Ste. 203 Greenfield, WI 53228-3407 Phone: 414-425-7710 Fax: 414-425-7424 International College of Dentists Dr. Christine Tempas 131 Cherry St. Sheboygan Falls, WI 53085 Phone: 920-467-4257 ctempas@intella.net

Madison Dental Progress Forum Dr. Gene Sorensen 216 S. Main St. Lodi, WI 53555 Phone: 608-592-4398 Email: lvdental@charterinternet.com Marquette University School of Dentistry PO Box 1881 Milwaukee, WI 53201-1881 General phone: 414-288-6500 Website: www.marquette.edu/dentistry Pierre Fauchard Academy – Wisconsin Dr. Gene Shoemaker 1600 Summit Ave., Ste B Waukesha, WI 53188-3236 Phone: 262-542-0431 Fax: 262-542-0326 Email: gopackshoe@aol.com Website: www.fauchard.org Wisconsin Academy of General Dentists Dr. Chris J. Hansen 1833 University Ave. Green Bay, WI 54302 Phone: 920-437-7444 Email: chansen@university-dental.com Website: www.wiagd.org Wisconsin Association of Endodontists Dr. David Gamm, President 1100 N Lynndale Drive Appleton, WI 54914 Phone: 920-731-4484 Email: davgamm@aol.com Website: www.aae.org

Wisconsin Dental Study Club Dr. Stuart J. McCormick 5610 Monticello Way Fitchburg, WI 53719-1602 Phone: 608-233-5351 Fax: 608-238-6777 Website: www.wisconsindentalstudyclub.com Wisconsin Society of Oral and Maxillofacial Surgeons Dr. Greg Santarelli, President 5021 Washington Road Kenosha, WI 53144 Phone: 262-654-6770 Email: greg@santarelliofs.com Website: www.wsoms.net Wisconsin Society of Orthodontists Dr. Charles Montoure, President 2000 Shady Lane Green Bay, WI 54313 Phone: 920-499-3721 Email: cmontoure@new.rr.com

Related Organizations

American Academy of Cosmetic Dentistry Barbara Kachelski 402 W. Wilson St. Madison, WI 53703 Phone: 800-543-9220 or 608-222-8583 Fax: 608-222-9540 Website: www.aacd.com

Wisconsin Society of Pediatric Dentistry Dr. Cesar Gonzalez Marquette University School of Dentistry 1801 W. Wisconsin Ave Milwaukee, WI 53233 Phone: 414-288-6391 Email: cesar.gonzalez@marquette.edu Wisconsin Society of Periodontists Dr. Edwin R. Schoeneberger, President 2316 N. Granview Blvd. Waukesha, WI 53188 Phone: 262-547-1877 Email: wergumz@gmail.com

Wisconsin Dental Assistants Association MaLea Flynn, CDA, CDPMA 14284 Spring Creek Road Mountain, WI 54149-9713 Phone: 715-276-7369 Email: malea@centurytel.net Wisconsin Dental Hygienists’ Association Lisa Bell, RDH, MPH, President, 2013-2015 1 W. Wilson St Madison, WI 53703 Phone: 608-266-3201 Email: lisabellrdh95@aol.com Website: www.wi-dha.com

2014 WDA Sourcebook

Dental Education

Blackhawk Technical College Dental Hygiene 6004 S. County Road G Janesville, WI 53546 Phone: 800-498-1282 or 608-758-6900 Website: www.blackhawk.edu Chippewa Valley Technical College Dental Assisting and Dental Hygiene 620 W. Clairemont Ave. Eau Claire, WI 54701 Phone: 800-547-2882 or 715-833-6346 Website: www.cvtc.edu Fox Valley Technical College Dental Assisting and Dental Hygiene 1825 Bluemound Road Appleton, WI 54912 Phone: 800-735-3882 or 920-735-5645 Website: www.fvtc.edu Gateway Technical College Dental Assisting 3520 30th Ave. Kenosha, WI 53144 Phone: 800-247-7122 or 262-564-2412 Website www.gtc.edu Lakeshore Technical College Dental Assisting and Dental Hygiene 1290 North Ave. Cleveland, WI 53015 Phone: 888-468-6582 or 920-693-1000 Website: www.gotoltc.edu Lake Superior College Dental Hygiene (Last dental hygiene class graduating 2016) 2101 Trinity Road Duluth, MN 55811 800-432-2884 or 218-733-7600 Website: www.lsc.edu 20

2014 WDA Sourcebook

Madison Area Technical College Dental Assisting and Dental Hygiene 3550 Anderson St. Madison, WI 53704 Phone: 800-322-6282 or 608-246-6065 Website: www.matcmadison.edu

Southwest Wisconsin Technical College Dental Assisting and Dental Hygiene 1800 Bronson Blvd. Fennimore, WI 53809 Phone: 800-362-3322, ext. 2354 or 608-822-2354 Website: www.swtc.edu

Marquette University School of Dentistry Dentistry only 1801 W. Wisconsin Ave. Milwaukee, WI 53201 Phone: 414-288-3093 (alumni office) or 414-288-3532 (admissions) Website: www.marquette.edu/dentistry

Waukesha County Technical College Dental Assisting and Dental Hygiene 800 Main St. Pewaukee, WI 53072 Phone: 262-691-5200 Website: www.wctc.edu

Milwaukee Area Technical College Dental Assisting, Dental Hygiene and Lab Technician 700 W. Highland Ave. Milwaukee, WI 53233 Phone: 414-297-6000 or 414-297-6263 Website: www.matc.edu Nicolet College Dental Assisting and Dental Hygiene 5364 College Drive Rhinelander, WI 54501 Phone: 715-965-4410 Website: www.nicoletcollege.edu Northcentral Technical College Dental Assisting and Dental Hygiene 1000 W. Campus Drive Wausau, WI 54401 Phone: 715-675-3331 Website: www.ntc.edu Northeast Wisconsin Technical College Dental Assisting and Dental Hygiene 2740 W. Mason St. Green Bay, WI 54307 Phone: 800-422-6982, ext. 5444 or 920-498-5543 Website: www.nwtc.edu

SERVE

COME TOGETHER House of Delegates

Pyramid of Pride Awards

InSession

Hands-On Latin Night

Learning

Creative

Technical

One-on-One

Exhibit Hall

Innovative

Speak Out

Social Events

InSession & House of Delegates November 13-15, 2014

The Wisconsin Center in Milwaukee

Continuing education doesnâ&#x20AC;&#x2122;t have to be boring. It doesnâ&#x20AC;&#x2122;t have to be all vast lecture halls and endless PowerPoint slides. WDA InSession offers hands-on courses and events with opportunities to connect with long-time friends and new colleagues. And, starting in 2014, it is combined with the WDA House of Delegates, so you can participate in your association firsthand. All conviently located in downtown Milwaukee. No big city traffic, hefty travel costs, airport hassles or unwieldy crowds.

Member Benefits and Resources

Member Benefits and Resources Joining the Wisconsin Dental Association is one of the best investments you can make in your dental career. WDA member dentists and dental hygienists have exclusive access to a host of goal-oriented (Advocate, Educate, Empower, Serve) benefits that make a difference in your dental practice and your profession. These goals support the WDA mission: Advance the interests of our members and the dental profession by promoting professional excellence and quality oral health care for the public.

ADVOCATE Oral health is critical to overall health, and healthy residents have significant, positive economic and social impact on Wisconsin. Reducing barriers and enhancing access to oral health care are top priorities under WDA Healthy Choices legislative and public awareness efforts which emphasize how patients benefit when they receive important oral health prevention and treatment in a timely manner in a dental home. The focus is on improving and simplifying the delivery of muchneeded dental care to Wisconsin families, as well as fostering a strong climate where dental practices can thrive, create jobs and help more people. A healthy state is attractive to new businesses, jobs and economic growth. WDA Healthy Choices proposals include: • Explore a pilot program that adjusts funding for Wisconsin’s dental Medicaid program • Provide incentives to encourage new dentists to settle in underserved areas • Emphasize prevention to stop dental problems before they start by incorporating a preventive education plan into state programs • Better use the dental team to allow dentists, as leaders, to treat more individuals while maintaining patient safety and upholding the quality and standard of care • Remove dental services from the southeast Wisconsin Medicaid HMO program Healthy Choices E-lert – Electronic newsletter for state political leaders, staff, oral health advocates and others interested in the overall well-being of the people of Wisconsin. E-Lerts are distributed periodically and include short articles, videos, photos, questions and answers with polictymakers and other information about WDA Healthy Choices initiatives. Community water fluoridation – Community water fluoridation helps all Wisconsin residents, regardless of age or economic status, maintain good oral health. The WDA works collaboratively with state agencies, oral health advocacy organizations, local health departments and member dentists

2014 WDA Sourcebook

and dental hygienists to educate community residents and elected officials about the benefits of public water fluoridation. If your community does not fluoridate its water or is considering adding or removing it from the public water supply, contact WDA Dental Practice and Government Relations Associate Erika Valadez at evaladez@wda.org or 888-538-8932 for assistance. Check out the fluoride info on WDA.org. Legislative support – With more than 3,000 licensed dentists and dental hygienists as members, the WDA is in a position to be the strongest, united professional dental voice before the Wisconsin Legislature. Members are kept informed about hot topics in oral health and encouraged to help represent dentistry’s professional interests before elected officials, state and local government organizations and the public. See page 57 for a complete list of WDA 2013-14 legislative priorities. Contact Mara Brooks at mbrooks@wda.org or 888-538-8932 for more information and to help make your dental voice heard in the legislative arena.

EDUCATE Rising incidence of tooth decay among young children, professional standards for examining and treating 1 year olds and a limited number of pediatric dentists in Wisconsin (approximately 80 percent of dentists are general practitioners) prompted the WDA to promote early childhood dental health by helping dentists turn their general practices into “dental homes” and educating the public about why Baby Teeth Matter (see page 23). Dental home continuing education materials (e.g., instructional video, supporting written information) are available on WDA.org (login required) to help general dentists and their dental teams become comfortable with examining and treating young children.

Give Kids A Smile® – Wisconsin dentists, dental team members, students and community volunteers have donated approximately $8.3 million in needed care and oral health instruction to 63,700 children from families with limited financial resources every February since 2003 as part of this annual national children’s dental access program. WDA’s GKAS® e-Update offers tips for in-office, group or componentwide events and classroom presentations. It makes it easy for event coordinators to register with the WDA and American Dental Association, giving access to special product promotions, planning tools and media support. Learn more about GKAS® and sign up for email updates on www.wda.org/dental-professionals/gkas.

Member Benefits and Resources Contact WDA Communications Coordinator Emily Bultman at ebultman@wda.org or 414-755-4110 for more information.

On average, $6 to $8 in care is provided for every $1 received from financial and in-kind donors. Nearly 11,400 children and adults have received $5.8 million in donated care at WDA Mission of Mercy events since 2009. MOM volunteers travel to Green Bay on June 27 and 28 in 2014. See page 29 for more information. Contact MOM Program Coordinator Lani Becker at lbecker@wda. org or 414-755-4114 for more information or visit the Mission of Mercy page under the WDA Foundation tab on WDA.org.

National Children’s Dental Health Month – February is National Children’s Dental Health Month. WDA members and local dental components are encouraged to actively educate youngsters about the importance of good oral health through classroom visits and other community events. The WDA has resources for members to use in school and community presentations. Visit WDA.org or contact WDA Communications Coordinator Emily Bultman at ebultman@wda.org or 414-755-4110 for details.

Visit Your Oral Health on WDA.org or contact WDA Director of Communications and Marketing Carol Weber at cweber@wda. org or 414-755-4108 for more information. Supplemental patient education materials – Multilanguage brochures, posters, flyers, stickers and magnets for “Sip All Day, Get Decay” and “Brush and Floss or Else…” can be purchased through The Dental Record by calling 800-243-4675 or visiting www.dentalrecord.com.

Member Benefits and Resources

The WDA and WDA Foundation Mission of Mercy marks six years in 2014. The program focuses on: • Providing free dental care, especially to patients with dental infections and/or in pain. • Raising awareness of the barriers to dental care faced by low-income adults and children. • Challenging patients, state policymakers and dental professionals to work together to improve all Wisconsin residents’ oral health.

$2.5 million campaign budget is made possible through dues and a $240 annual (2014 - 2016) special assessment approved by the WDA House of Delegates in November 2013. • Baby Teeth Matter helps parents and caregivers understand the importance of baby or primary teeth to a child’s early physical, social and emotional development. • Brush and Floss or Else… addresses the impact of oral health on overall well-being, including heart disease and diabetes management. • Sip All Day, Get Decay educates the public about the dangers of consuming too many sugary, acidic beverages and the important roles nutrition and prevention play in maintaining good oral health.

This patient newsletter offers a wide variety of dental health and personal oral hygiene information in every issue. The print version is published twice a year (spring/summer and fall/winter). It is distributed to members with the WDA Journal for dentists to display in their reception areas and dental hygienists to use with chair-side discussions. Everyone – members, patients, family, friends, colleagues, general public, media – are invited to “subscribe” to the electronic version which is issued four times a year (winter, spring, summer and fall). Visit WDA.org to subscribe.

EMPOWER Public awareness – Public awareness campaigns educate the public, policymakers, media, member dentists and dental teams about important oral health issues, while building appreciation and respect for the dental profession and organized dentistry. A recent statewide public survey showed 70 percent of Wisconsin adults (18 and older) had heard of or were familiar with the WDA, compared to less than 20 percent when first tracked in the early 1990s. In addition, 91 percent of residents have a favorable opinion of dentists. • Own Your Smile is the WDA’s new strategic, oral health literacy, public awareness campaign. Kicking off a three-year run in January 2014, it is motivating adults statewide to make good oral health a priority and to seek affordable, preventive care in member dentists’ practices with or without dental “insurance”. A comprehensive communications and marketing plan includes multiple television and radio spots, press releases, media appearances by member dentists, expanded public information on WDA. org and social media posts with the #OwnYourSmile hashtag. The

Component support – WDA staff is available to help components plan meetings (e.g., secure a facility and/or continuing education speaker, collect RSVPs) and notify members of other local dental society activities. Visit your component page on WDA.org for a list of current officers and their contact information, photos from recent events and upcoming meeting dates. The WDA Component Connection e-newsletter is sent periodically to all component officers to encourage the sharing of best practices and provide volunteer leaders with tools and resources for managing and operating local dental societies. Contact WDA Member Relations Coordinator Betsy Krekling at 800-364-7646 (toll-free), 414-755-4126 (direct) or bkrekling@ wda.org for component support.

WDA

WISCONSIN DENTAL ASSOCIATION

By contributing to the Wisconsin Dental Political Action Committee (WIDPAC, Direct Giver, American Dental Political Action 2014 WDA Sourcebook

Member Benefits and Resources

Committee), WDA Political Action Team members work together to build and strengthen bipartisan legislative relationships through financial support of legislators and candidates who discuss, understand and support dental-related issues.

The goal of Legislative Day is to help WDA member dentists and dental hygienists and Marquette University School of Dentistry students become comfortable communicating oral health messages to elected officials of both political parties. Attend Legislative Day and exercise your constituent rights by supporting WDA as the “Tooth Party”. Help advance issues that promote professional excellence and quality oral health care for the public. Save the date for WDA Legislative Day on March 18, 2015 at Monona Terrace in Madison.

SERVE

New in 2014! Pay member dues and secure advertising online

Visit WDA.org and click on the “Join/Renew Membership” button at the top of any page or go directly to www.shopwda.org and click on “Membership Dues” in the main menu. Looking place a classified ad? Ads can now be purchased and submitted at any time at www.shopwda.org. Five classified ad sizes are offered and additional options can be selected to customize your ad. Contact Emily Bultman at ebultman@wda.org or 414-755-4110 with questions.

RESOURCES This annual member directory and practice guide is a valuable desktop reference for dentists, dental hygienists and other dental team members. Tabs provide quick access to the member directory and important practice information including the Wisconsin Practice Act, administrative rules and frequently asked practice and legal questions. The print edition mails in early spring. The WDA Sourcebook is also available on WDA.org as a downloadable PDF and in an electronic flip-format. Member login required.

This print and electronic publication is distributed as needed to provide members with timely, pertinent information about the association’s position on important issues facing the dental profession.

The WDA Journal is the official publication of the state association. A monthly, full-color publication, it keeps WDA members current on the latest state dental news. Popular recurring features include Government Buzz, Business of Dentistry and Calendar of Events with continuing education offerings. In addition, every issue of the WDA Journal is posted on WDA. org as a downloadable PDF and in an electronic “flip” format. Member login required.

The WDA Executive Director’s Update is emailed to dentist and dental hygienist members on the last business day of every month with late-breaking association and dental-related regulation, compliance, legislative and community news. Get the most out of your dues dollars by providing the WDA Executive Office with a current email address. We respect members’ privacy and do not sell or share email addresses with any third party.

2014 WDA Sourcebook

The WDA website provides WDA dentist and dental hygienist members with exclusive access to resources important to career success and day-to-day practice management. Get answers to common questions about dental records, delegation of duties, continuing education requirements, patient privacy and more. Patients and the general public can also fine important and helpful dental health information, and get help in choosing a dental home using the “Find A WDA Dentist” button Recognized as a go-to oral health information resource by members, patients, news media and the public, WDA.org is available 24/7. The WDA has a suite of seven electronic newsletters that offer members, elected officials, patients, oral health advocates and the general public timely information. Visit WDA.org to manage your newsletter subscriptions. Contact WDA Electronic Communications Coordinator Amanda Brezgel at abrezgel@wda.org or 414-755-4112 for more information.

Member Benefits and Resources

Social networking offers an information-rich online world with almost limitless opportunities for educating patients, lawmakers, media and the general public about important personal oral health topics and dental-related issues.

Now you can also follow the WDA on LinkedIn to connect with dentist and dental hygienist colleagues, MUSOD students and dental industry contacts.

WDA CareerConnection is the only online job center exclusively for dental careers and employment connections in Wisconsin serving dentists, dental hygienists, assistants, lab techs and more. For more information, visit careers.wda.org.

The WDA Foundation’s confidential Dentists Concerned for Dentists program was established in 1986 to help those who struggle with problems associated with alcohol or chemical dependency, depression, infectious diseases and other well-being issues. Chemical dependency and addiction endanger health, upset social, family and business relationships and affect job performance. The WDA Foundation and WDA are committed to helping members of the dental profession who’s personal and professional lives are jeopardized by well-being issues. Contact Susan John at sjohn@wda.org or 414-755-4118 for assistance. All cases are strictly confidential. See page 30 for more information or learn more at WDA.org.

Mediation Services – A long-standing service of the WDA, this program offers patients and dentists an opportunity to resolve differences without the expense of the legal system or going before the Dentistry Examining Board. The WDA serves as an impartial “middle man” with every effort made to treat both sides fairly throughout the disagreement. Trained volunteer dentists (generalists and specialists) base their decisions and recommendations on careful review of evidence provided and reached in a fair and objective manner. Visit WDA.org to learn more or contact WDA Mediation Services Coordinator Kris Anderson at kanderson@wda.org or 414-775-4120. Pyramid of Pride Awards - This annual recognition program is a way to thank colleagues, members and friends of the dental community for outstanding contributions to the profession and oral health care. Beginning in 2014, recipients will be recognized during the annual WDA House of Delegates meeting and celebrated during a reception in the InSession exhibit hall.

Member Benefits and Resources

Show your support for and affiliation with the WDA while getting the latest updates, photos and videos in your news feed when you “like” the WDA on Facebook, follow us on Twitter, watch WDA-TV reports on YouTube and check out dental-related photos on Flickr and Pinterest.

Mentor Program - An award-winning partnership between the WDA, Marquette University School of Dentistry and the Pierre Fauchard Academy, this program helps dental students and practicing professionals to connect. Students obtain counsel and guidance as they prepare to begin their dental careers. Mentors identify potential associates and help build dentistry’s future. See page 27 for more information.

Recognition categories include:

Recognize a • Lifetime Achievement colleague, member • Community Outreach friend for their ou or • WDA Foundation Philanthropic ts • Friends of Dentistry contribution to dent tanding istry • Media Relations See page 102 ! • Media Awareness for details. • New Dentist Leadership • Outstanding Leadership in Mentoring • Political Action • WDA Award of Honor Nomination deadline is Tuesday, July 15, 2014. See page 102 for the 2014 POP nomination form.

Save the dates: Nov. 13-15, 2014 Wisconsin Center, Milwaukee InSession is Wisconsin’s largest dental study club. Beginning this year, WDA InSession moves to the fall and will be held in conjunction with the WDA House of Delegates. Join us for three days packed with continuing education, networking, team building, honoring colleagues and determining organized dentistry’s future in the Badger State. • Hear about the latest developments in dentistry when you converse one-on-one with nationally-respected lecturers, peer experts and dental industry representatives about YOUR concerns and ideas. • See your professional association “in action” and voice your opinions to your elected organized dentistry representatives. • Do mark your calendar and plan now to attend THE Wisconsin dental meeting: WDA InSession and House of Delegates, Nov. 13 - 15, 2014! See page 21 for more information or learn more at WDA.org.

Contact WDA Member Relations Coordinator Betsy Krekling at bkrekling@wda.org or 414-755-4126 or visit WDA.org for more information.

Recommended Products, Programs and Services – From appointment aids to website design, WDA members can tap more than 20 endorsed programs to save money on dental office essentials, products, services and more. See pages 100-101 for more information.

Professional Insurance Programs – Take advantage of WDAendorsed liability, property, life, disability overhead, employee benefits, health insurance and personal lines. These products and more are available through PIP – a full-service insurance agency for the dental profession. See page 102 for more information.

2014 WDA Sourcebook

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Mentor Program SERVE

Mentor Program A joint effort of the Wisconsin Dental Association, Marquette University School of Dentistry and the Pierre Fauchard Academy, the Mentor Program began 19 years ago to help guide students in their journey into dentistry. The program is intended to build lasting relationships among future colleagues, as well as allow students and practicing dentists to learn about obstacles facing the profession and how to accomplish dental goals.

Mentor Program

Benefits of being a mentor:

• Network with colleagues • Share expertise and experience • Aid in developing dentistry’s future professionals • Give back to the profession • Stay apprised to changes in dental education

Responsibilities of a mentor

• Provide opportunities for protégé to see firsthand the inner workings of the dental office • Invite students to participate in professional activities with you (component meetings, continuing education, etc.)

How do I become a mentor?

To become a part of our award-winning program, contact Susan John at sjohn@wda.org or 414-755-4118.

Mark your calendar! Future Mentor Program kick-off dinners: • Sept. 29, 2014 • Sept. 28, 2015 • Sept. 26, 2016

2014 WDA Sourcebook

WDA Foundation

The WDA Foundation is committed to making a difference by improving the oral health of Wisconsin residents through its support of projects that provide dental care for the disadvantaged, while meeting the current and future needs of the dental profession.

Making a difference WDA Foundation

Your contribution helps the WDA Foundation to: • Administer Donated Dental Services • Underwrite a portion of the cost for the Mission of Mercy • Sustain the annual grant program which helps the less fortunate by supporting statewide dental health programs and clinics • Award annual scholarships to deserving Wisconsin dental and dental hygiene students • Support current dental professionals through Dentists Concerned for Dentists and the Relief Fund

How you can help Make a donation You can support the WDA Foundation by making an independent donation at any time of the year.

You can he WDA Foundlpatthione make a difference!

Donations can be made via check, credit card (Visa, MasterCard and Discover accepted), cash or online at WDA.org/wda-foundation. Contributions can be mailed to: WDA Foundation, Inc. • 6737 W. Washington St., Suite 2360 • West Allis, WI 53214

Other ways to give • • • • •

Contribute through your annual membership dues statement Remember the WDA Foundation in your will or trust Make a gift of stock or securities Designate all or a percentage of your precious scrap metal recycling proceeds through the Scientific Metals donation program Support foundation special events

Contact WDA Foundation Executive Director Vicki Bohman at vbohman@wda.org or 414-755-4198 or visit www.wda.org/wda-foundation for more information. Established in 1957, the Wisconsin Dental Association Foundation is a 501(c)(3) charitable organization. Donations to the WDA Foundation are tax-deductible to the full extent of the law.

Mark your calendar! The Wisconsin State Dental Golf Tournament is set for Monday, Sept. 8 2014 at the Legend at Brandybrook in Wales. Proceeds from the event benefit the WDA Foundation.

2014 WDA Sourcebook

Mission of Mercy EDUCATE

June 27 - 28, 2014 at KI Center in Green Bay 2014 MOM goals Log 2,000 patient visits Recruit 1,000 dental and community volunteers

The Wisconsin Dental Association and WDA Foundation will team up for their sixth Mission of Mercy at the KI Center in Green Bay on Friday, June 27 and Saturday, June 28. (Setup is Thursday, June 26, teardown will immediately follow clinic close.)

Mission of Mercy

Provide $1 million in charitable dental care

Treatment offered includes diagnosis by a dentist; fillings; extractions; limited, front-teeth transitional partials; and cleanings.

A successful MOM event focuses on: • Providing free, critical dental care with a high priority on treating patients in pain and with infections • Raising public awareness of the barriers to dental care faced by low-income adults and children • Challenging patients, policymakers and dental professionals to work together to make viable and bipartisan “Healthy Choices” that will improve Wisconsin residents’ oral health

Become a MOM volunteer More than 1,000 volunteer dentists, dental hygienists and assistants, lab technicians and community helpers are needed during the four days. Please consider volunteering for a half day, whole day or more. Visit WDA.org for more information and to register, or contact MOM Program Coordinator Lani Becker at lbecker@wda.org or 414-755-4114.

It’s the smiles – not the miles – that make it a mission!

Mission of Mercy is a program of the WDA and the WDA Foundation.

SAVE THE DATE! MOM 2015 June 12 and 13 Fond du Lac area

2014 WDA Sourcebook

WDA Foundation Programs

Donated Dental Services The mission of the Wisconsin Dental Association Foundation’s Donated Dental Services program is to help disabled, elderly and medically-compromised people access comprehensive dental care they could not otherwise obtain.

WDA Foundation Programs

DDS clients cannot work because of age or disabilities and public aid programs, such as Medicaid, do not meet their oral health needs. • • • •

Started in 1998, DDS has been delivering needed dental care for more than15 years More than 3,011 disabled, elderly and medically compromised people have been treated $8.4 million in free, comprehensive treatment has been donated More than 802 Wisconsin dentists and 155 dental labs have volunteered throughout the Midwest

Funds for DDS staff support and lab costs have been provided by the Wisconsin Department of Health Services, Delta Dental of Wisconsin Charitable Fund and WDA Insurances and Services Corp.

Become a DDS volunteer

The Donated Dental Services program is looking for volunteers just like you! Although many dentists throughout the state generously donate their time and services, the program still needs more dentists to get involved. As another year begins, hundreds of vulnerable Wisconsin residents are in need of dental care. Contact: Carol Shoemaker, DDS Director Email: cshoemaker@wda.org Phone: 888-338-6852 or 414-755-4188 Fax: 414-276-8431 For southern and eastern Wisconsin (Calumet, Dodge, Door, Fond du Lac, Grant, Green, Jefferson, Kenosha, Kewaunee, Lafayette, Manitowoc, Milwaukee, Ozaukee, Racine, Rock, Sheboygan, Walworth, Washington, Waukesha and Winnebago counties) Contact: Carrie Golabowski Email: cgolabowski@wda.org Phone: 866-812-9840 or 414-755-4190 Fax: 414-276-8431 For all other counties

SERVE

Dentists Concerned for Dentists, through the financial support of the WDA Foundation, has been able to help those who have problems with alcohol or chemical dependency, depression, infectious diseases or other well-being issues. DCD is confidential and nonpunitive. It believes affected dentists are best diagnosed and treated by professionals while being supported by peers – people in the same profession who know and deal with the stresses of running a dental practice. All calls remain confidential. For more information or to seek treatment for yourself or someone else, contact WDA Member Services Representative Susan John at sjohn@wda.org or 414-755-4118.

Relief Fund A charitable grant program, the WDA Relief Fund helps dentists or their surviving dependents meet daily living expenses when they are not otherwise able to do so. Whether put in a financial bind because of an extended illness, physical disability or other emergency situation, the Relief Fund can help ensure you are able to have food on your table, a roof over your head and clothes on your back. Grants are intended to help cover temporary basic needs and do not need to be repaid. However, they are not intended to fund retirement plans or put children through college. Confidentiality is maintained at all times. If you or someone you know could use assistance, contact WDA Member Relations Coordinator Betsy Krekling at bkrekling@wda.org or 414-755-4126 for more information or to apply.

2014 WDA Sourcebook

THANK ! u o Y

and all the 2014 WDA Sourcebook (Member Directory & Practice Guide) advertisers for your generous support.

Page 15

Tab ad - WI Dental Practice Act/ WI Admin Rules/FAQs & Member Directory

Page 133

Tab ad - Member Directory

Page 131

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Tab ad - WI Dental Practice Act/ WI Admin Rules/FAQs

Back cover

Inside back cover

Inside front cover

Page 76

Page 79

2014 WDA Sourcebook

WDA Bylaws

WDA Bylaws Table of Contents ARTICLES OF INCORPORATION...........................................................32

Chapter IX - Special Meetings of the Membership..............................41

BYLAWS...........................................................................................33

Chapter X - Publications....................................................................41

Chapter I - Membership....................................................................33

Chapter XI - Finances.......................................................................41

Chapter II - Component Societies.......................................................35

Chapter XII - Indemnification of Officers, Trustees, Employees,

Chapter III - House of Delegates.......................................................35

Agents and Committee Members..................................41

Chapter IV - Board of Trustees..........................................................37

Chapter XIII - Amendments...............................................................42

Chapter V - Elective Offices...............................................................39

Chapter XIV - Referendum................................................................42

Chapter VI - Appointive Offices.........................................................40

Chapter XV - Rules of Order..............................................................42

Chapter VII - Committees..................................................................40

Chapter XVI - Principles of Ethics.......................................................42

Chapter VIII - Scientific Session.........................................................40

Chapter XVII - Conflict of Interest......................................................42

AMENDED AND RESTATED ARTICLES OF INCORPORATION OF WISCONSIN DENTAL ASSOCIATION, INC. The following amended and restated articles of incorporation of WISCONSIN DENTAL ASSOCIATION, INC., duly adopted pursuant to the authority and provisions of Chapter 181 of the Wisconsin Statutes, supersede and take the place of the existing articles of incorporation and any amendments thereto: Article I - Name The name of the corporation is WISCONSIN DENTAL ASSOCIATION, INC. Article II - Purposes: Powers This corporation is organized to advance the science and art of dentistry: to further elevate the standard of dental education; to aid in further improving the public health, and in particular oral health; to promote the scientific and other professional interests of its members; and to acquire by gift, inheritance, or purchase such real and personal property as may be necessary or desirable in the fulfillment of the foregoing purposes. To accomplish its objectives, the corporation may exercise any and all powers conferred on it by Chapter 152 of the Wisconsin Statutes, 1961, together with powers not inconsistent therewith conferred on a non stock corporation organized under Chapter 181 of said Statutes. Article III - Members The corporation shall have active members. Other classes of membership may be established in the Bylaws. The Bylaws shall also prescribe the qualifications, rights and methods of acceptance of active members and any other classes therein established. Article IV - Board of Trustees The affairs of the corporation shall be managed by a board of directors known as the Board of Trustees, which shall consist of the number fixed by the Bylaws, but not less than three (3). The qualifications, manner of selection, terms of office, and the area represented by each trustee shall be prescribed by the Bylaws. Any action required or permitted to be taken at a Board of Trustees meeting may be taken without a face-to-face meeting by written action signed by two-thirds of the Trustees then in office. Article V - Officers The designations of offices and the qualifications, terms of office, and manner of election of officers shall be prescribed by the Bylaws. Article VI - Principal Office: Registered Agent The principal office of the corporation shall be located in Wisconsin. The name of its registered

2014 WDA Sourcebook

agent is Mark S. Paget, whose address is 6737 W. Washington Street, Suite 2360, West Allis, Wisconsin 53214. Article VII - Fiscal Restrictions on Corporation and Others This corporation shall issue no capital stock of any kind and pay no dividends to its members; and no part of its net income or any of its assets, on liquidation or otherwise, shall be distributed to or inure to the benefit of a trustee or officer, provided that the Board of Trustees may establish and pay reasonable compensation for services rendered to the corporation by a trustee or officer. Article VIII - Dissolution In the event of dissolution, and except as otherwise provided by Chapter 181, Wisconsin Statutes, as amended, after the payment of or provision for all obligations, the then remaining assets of the corporation, real and personal, shall be conveyed, as may be determined by the Board of Trustees, or the legal administrator of the corporation, pursuant to the cy pres doctrine, to one or more nonprofit corporations, organized and operated for purposes substantially similar to or consistent with one or more of the purposes of this corporation. Article IX - Chapter 181 Election To the extent not inconsistent with provisions of Chapter 152, Wisconsin Statutes and any amendments thereof, the corporation elects to become subject to Chapter 181, Wisconsin Statutes, also known as â&#x20AC;&#x153;The Wisconsin Non-stock Corporation Law.â&#x20AC;? Article X - Effect of Restatement These Amended and Restated Articles of Incorporation shall supersede and take the place of the heretofore existing legislative charter granted to the Association by Chapter 462, Private and Local Laws of Wisconsin, 1871. Article XI - Amendment of Articles These Amended and Restated Articles of Incorporation may be amended in the manner provided by law. These Amended and Restated Articles of Incorporation of the corporation were adopted on May 31, 2006, in accordance with Section 181.1003 of the Wisconsin Statutes. Dated as of the third day of August 2006. By: Mark S. Paget, Secretary This document was drafted by and is returnable to: W. Charles Jackson, Esq. Michael Best & Friedrich LLP 100 East Wisconsin Avenue, Suite 3300 Milwaukee, Wisconsin 53202-4108 (414) 271-6560

WDA Bylaws

BYLAWS CHAPTER I - MEMBERSHIP Section 10. Classifications. The members of this Association shall be classified as follows: active, affiliate, life, retired, full-time faculty, student, honorary, provisional, state public health, dental hygienist and associate. The qualifications and classifications of membership in this Association shall be the same as those of the American Dental Association, with the exception of state public health, dental hygienist, associate and full-time faculty members. Section 20. Qualifications. A. Active. 1. Qualifications. A licensed dentist who resides in, or is licensed in the State of Wisconsin, shall be eligible for active membership providing he or she is a member in good standing of the American Dental Association and a component of this Association.

Except as otherwise expressly provided herein, an active member shall be eligible for election to any position or office in the Association, or to any position or office outside the Association to which the officers or membership of the Association have appointive or elective powers. 3. Dues. The dues of active members shall be established annually by the House and shall be due on Jan. 1 of each year. Active members who move from the state may retain their membership in this Association by notifying the executive director of their desire to be placed on an affiliate membership list, and by regularly paying an annual fee as established by the House of Delegates (elsewhere referred to as â&#x20AC;&#x153;Houseâ&#x20AC;?), providing that they annually submit proof that they are members currently in good standing of the local and state societies in whose jurisdiction they practice. Those having lost their membership by moving, if still in reputable practice, may also attain affiliate member status providing that they follow the same procedure outlined for active members who have moved from the state. B. Affiliate. 1. Qualifications. A dentist practicing in a state other than Wisconsin or in a country other than the United States who is a member of the American Dental Association or a national dental organization, if such exists, in such country, or a dentist who is not licensed in Wisconsin but who is engaged in full-time educational, public health, or governmental work within the state and who is a member in good standing of the ADA either through another constituent society or as a direct member, may be classified as an affiliate member upon application to the executive director and upon proof of qualification. 2. Privileges. An affiliate member shall receive annually an evidence of membership and the JOURNAL, the subscription price of which shall be included in annual dues. An affiliate member shall be entitled to admission to any scientific session of the association, under rules and regulations established by the Board of Trustees, and to such other services as are authorized by the Board of Trustees. 3. Dues. The dues for affiliate members shall be established annually by the House and shall be due on Jan. 1 of each year. C. Life 1. Qualifications. An Association member who has been an active member in good standing of the American Dental Association for 30 consecutive years or a total of 40 years of active and/or retired membership and who has attained the age of 65 years in the previous calendar year shall be eligible for life membership.

2. Privileges. A life member in good standing shall have the same rights and privileges as an active member. 3. Dues. Life members shall be subject to dues as established annually by the House along with those dues imposed by the American Dental Association and the component society. D. Student. 1. Qualifications. A pre-doctoral student of a dental school is eligible for this category of membership providing that he or she is an American Student Dental Association member. 2. Privileges. A student member in good standing shall have the same rights and privileges as an active member but without the right to hold office. Student members may be advisory members to House Committees. Students serving as Region 6 delegates of the House may vote on House matters as defined in Chapter III, Section 40 and 50. 3. Dues. Student members shall be exempt from the payment of all Association dues. E. Honorary. 1. Qualifications. An individual who has made outstanding contributions to the art or science of dentistry, or who has rendered important services to the dental profession, and who has been nominated by the Board of Trustees, shall be eligible for election as an honorary member by the House.

WDA Bylaws

2. Privileges. An active member in good standing shall have voting privileges. An active member shall receive annually an evidence of membership and the JOURNAL, the subscription price of which shall be included in annual dues. An active member shall be entitled to admission to any scientific session of the Association, under rules and regulations established by the Board of Trustees, and to such other services and benefits as are provided by the Association.

An active member, who had been such when entering upon active duty in one of the armed services or equivalent duty in the Public Health Services, but who, during such military or equivalent duty, interrupted the continuity of active membership because of failure to pay dues and who, within one year after separation from such military or equivalent duty, resumed active membership, may pay back dues for any missing period of active membership at the rate of dues current during the missing years of membership for the purpose of establishing continuity of membership in order to qualify for life membership.

2. Privileges. An honorary member shall receive a certificate of membership and subscription to the JOURNAL. Unless an honorary member is also an active or life member, he or she shall not be entitled to vote or hold office, but shall be entitled to admission to any scientific session under rules and regulations established by the Board of Trustees. 3. Dues. Honorary members shall be exempt from the payment of all association dues. F. Retired. 1. Qualifications. An active member in good standing who is retired and no longer earning income from the performance of service as a member of the faculty of a dental school, as a dental administrator or consultant, or as a practitioner of any activity for which a license to practice dentistry or dental hygiene is required by the State may be classified as a retired member. To apply for retired membership status, the active member shall submit an affidavit attesting to retirement through the component society. The component society shall submit verification of such retirement to the executive director for approval and subsequent referral to the ADA. Maintenance of active or retired membership in good standing in the component society and ADA entitling the member to all the privileges of an active member shall be requisite for entitlement to and continuance of retired membership in this Association. 2. Privileges. A retired member in good standing shall have the same rights and privileges as an active member. 3. Dues. The annual dues of retired members shall be established annually by the House and shall be due on Jan. 1 of each year. G. Provisional. 1. Qualifications. Provisional membership shall terminate Dec. 31 of the calendar year following the year of graduation. To be a provisional member, a dentist: a. Shall have received the degree of DDS or DMD from a dental school accredited by the Commission on Accreditation of the American Dental Association; b. Shall not have established a place of practice; and 2014 WDA Sourcebook

WDA Bylaws

WDA Bylaws c. Shall have applied for provisional membership within 12 months of graduation. 2. Privileges. A provisional member in good standing shall receive all the privileges afforded an active member except that, notwithstanding anything in these Bylaws to the contrary, a provisional member shall have no right to appeal from a denial of active membership in the Association.

2. Privileges. A state public health member shall receive an annual evidence of membership, existing electronic newsletters and the WDA Journal, the subscription of which shall be included in the annual dues, and that they have access to the members’ only section of the WDA website. They shall also be entitled to admission to any scientific session of the Association, under rules and regulations established by the Board of Trustees, and to such other services as are authorized by the Board of Trustees.

3. Dues. The annual dues of provisional members shall be established annually by the House and shall be due on Jan. 1 of each year.

3. Dues. The annual dues of this classification shall be 25 percent of the active membership dues as established annually by the House and shall be due on Jan. 1 of each year.

H. Dental Hygienist 1. Qualifications. A dental hygienist who is licensed by the State of Wisconsin.

Section 30. Good Standing. A. Dues. Any member, who has paid the dues for which he or she is liable to the Association, and who has not been suspended or expelled from the Association, shall be considered in good standing. Suspension does not interfere with the continuity of the member as related to life membership provided that the member pays dues while suspended. An expelled member shall not be assessed dues for the period of expulsion nor shall the period of expulsion be credited toward continuity of membership. An expelled member shall not be considered a member in good standing.

2. Privileges. A dental hygienist in good standing shall receive an annual evidence of membership, electronic newsletter and the WDA Journal, the subscription of which shall be included in the annual dues, and have access to the members’ only section of the WDA website. They shall also be entitled to admission to any scientific session of the Association, under rules and regulations established by the Board of Trustees, and to such other services as are authorized by the Board of Trustees. 3. Dues. The dues shall be established annually by the House of Delegates and set at the same rate as Affiliate Members. Dues are due Jan. 1 of each year. I. Associate. 1. Qualifications. In the interest of uniting all persons who contribute significantly to the dental team, for the betterment of the profession of dentistry, the following persons may become Associate members of this Association with such privileges and benefits as shall be established from time to time by the House: a. Dental Assistant. Any person who works as a chair side, roving or sterilization assistant, or any other person who assists in the delivery of dental services. b. Administrative Staff. Any person who is a receptionist, bookkeeper, secretary, insurance claims manager or occupies another administrative position in a dental office. c. Dental Laboratory Technician. An individual who is certified as a dental laboratory technician in Wisconsin. A licensed dentist or dental hygienist may not become an associate member nor may they obtain member benefits through an associate member. 2. Privileges. An associate member in good standing shall receive a certificate of his or her membership. An associate member shall be entitled to admission at a reduced fee to the Association Annual Session, and shall be entitled to such other benefits as shall be established by the House from time to time. 3. Dues. The annual dues of associate members shall be established annually by the House and due on Jan. 1 of each year. J. Full-time Faculty. 1. Qualifications. A licensed dentist who resides in or is licensed in the State of Wisconsin, and who is a full-time member of the Marquette University School of Dentistry faculty or administration, shall be eligible for full-time faculty membership providing he or she is a member in good standing of the American Dental Association and a component of this Association. 2. Privileges. A full-time faculty member in good standing shall have the same rights and privileges as an active member. 3. Dues. The annual dues of this classification shall be 25 percent of the active membership dues as established annually by the House and due on Jan. 1 of each year. K. State Public Health. 1. Qualifications. A licensed dentist who resides in or is licensed in the State of Wisconsin, and who is a full-time employee of the State of Wisconsin holding a master’s degree in public health and not working in a private practice.

2014 WDA Sourcebook

B. Dues Forgiveness. Any member receiving assistance from the Relief Fund of this Association shall be exempt from the payment of dues and shall remain a member in good standing. A member who has suffered a catastrophe, medical illness or who is experiencing a financial hardship as certified by the component society secretary shall be eligible for a waiver or reduction of the current year’s dues, provided the component also waives or reduces the current year’s dues. These exemptions shall be reviewed annually. Waivers granted due to financial hardship may be granted for a maximum of three years. C. Loss of Membership and Reinstatement. A member who fails to pay the dues for which he or she is liable by March 31 of the year for which dues are to be paid shall cease to be a member of this Association. A former active member, for reinstatement to active membership, shall be required to pay the current year’s dues. D. Payment Date and Installment Payments. For those members who participate in an expanded installment dues payment plan sponsored by the Association, they shall be required to fully pay the current year’s dues by May 15 to maintain their good standing. Section 40. Disciplinary Proceedings. A. Right of Hearing. Any member or duly constituted review committee as a whole may file a written charge against any other member based upon one or more of the following allegations: 1. That the charged member has been found guilty of a felony; or 2. That the charged member has had his/her license revoked due to a violation of the Dental Practice Act; or 3. That the charged member has violated one or more provisions of these Bylaws or of the Principles of Ethics of this Association. All such charges will be considered initially by the state Ethics and Dental Relations Committee of the charged party. The charged party shall have a right of hearing before the state Ethics and Dental Relations Committee in accordance with guidelines prescribed by this Association. If either the complaining party or the charged party is a member of the state Ethics and Dental Relations Committee, unless the complaining party is a duly constituted review committee of the whole, then the complaining party or the charged party shall not participate in deliberative proceedings relating to the matter. The hearing shall be held promptly in accordance with the guidelines previously mentioned. Both the complaining party and the charged party shall have the right to appear at the hearing personally and/or through any friend or attorney and to file a written brief or argument within time limits prescribed by the Ethics and Dental Relations Committee. The complaining party shall be considered a non-voting member of the Ethics Committee for purpose of all considerations relating to the charge and the charge shall be a part of the Committee record.

WDA Bylaws B. Right of Appeal. 1. Board of Trustees. Either the complaining party or the charged party may appeal any action or lack of action by the Ethics and Dental Relations Committee to the Board of Trustees by filing an appropriate affidavit of appeal with the executive director of the State Association. The affidavit of appeal must summarize the charges, the actions or failures to act of the Ethics and Dental Relations Committee, and it must specify the nature of the appellant’s objections to such actions or failures to act. If either the complaining party or the charged party is a member of the Board of Trustees, then the complaining party or the charged party shall not participate in any hearing or in any other deliberative proceedings by such committee relating to the matter. The Board of Trustees shall permit either written or oral arguments, or both, to be presented to it by the complaining party, the charged party, and the Ethics and Dental Relations Committee, or their designated friends or attorneys. Any appeal to the Board of Trustees shall be considered by the Board at its next regular or special meeting.

3. Time Limits and Notices. No appeal of any decision shall be valid unless the required affidavit of appeal is sent by registered mail within 30 days after the written decision being appealed has been rendered and mailed to the parties involved, to the body from which the appeal is being taken, and to the body to whom the appeal is being taken. No decision shall become final while a timely appeal is still pending. 4. Summary and Record on Appeal. When an appeal is taken from a decision of a component Ethics Committee, the committee shall, within 15 days after receipt of the affidavit of appeal, mail to the executive director of the Association a summary and, if available, a transcript of the hearing, plus all written briefs and arguments submitted to the committee. The summary must list all persons who were present at the hearing and their files, the charge or charges, and a summary of the evidence produced. It shall be certified as to accuracy by the chairman of the Ethics and Dental Relations Committee. A similar summary shall be made by the Board of Trustees in instances where timely appeals are taken from such Board of Trustees to the American Dental Association; and that summary, and, if available, a transcript of the hearing, plus all written briefs and arguments shall be mailed to the American Dental Association and certified as to accuracy by the chairman of the state committee.

CHAPTER II - COMPONENT SOCIETIES Section 10. Conditions of Charter. Any county or local dental society in Wisconsin which shall have adopted articles, a constitution and bylaws or any of those instruments, may submit all such papers to the House to apply for a charter as a component society. If the House approves the form of the articles, constitution and bylaws or bylaws only, and finds such documents or document free from conflict with the Articles and Bylaws of this Association, it may issue a charter. A continuing condition of retention of such charter shall be that such documents shall remain free from such conflict and in a form approved by the Association. Thus all changes in such component society’s articles, constitution, or bylaws shall be filed with the executive director of this Association within 30 days after their adoption or amendment. For good cause, and after hearing, of which there has been written notice of not less than 30 days, the House may revoke the charter of a component society. Procedures and guidelines for such hearing shall be promulgated by the Board of Trustees. Section 20. Trustee Regions. The membership in each trustee region must be made up exclusively of members of the component societies, with the exception of the student region. This student region shall be comprised of Marquette University School of Dentistry ASDA members who are Wisconsin residents and members of the Association.

Section 40. Change of Practice Location. When a member in good standing of a component society changes practice location in this state, the member’s name may be transferred without further payment of dues for that particular year to the roster of the component society located in the area of the new practice location, subject to the approval of that component. Section 50. Choice of Component Society. A dentist practicing near a component boundary may, with the permission of the society in whose jurisdiction he or she practices, hold membership in the component society in which it is more convenient to be active providing the individual is acceptable to the society. A dentist practicing in areas of more than one component society shall hold membership in the component society of his or her choice providing the individual is acceptable to the society. Section 60. Membership Roster. The secretary of each component society shall keep an up-to-date roster of its members. The component secretary shall make an annual report of this roster to the executive director of this Association, according to classifications established by the latter.

CHAPTER III - HOUSE OF DELEGATES Section 10. House Session. The House of Delegates shall meet annually in the fall; a second meeting may be held at the discretion of the Board of Trustees, or a special session may be held pursuant to Section 90.

WDA Bylaws

2. American Dental Association. The only further appeal which can be made is one to the American Dental Association in instances when such an appeal is in conformance with the Bylaws and rules of that organization.

Section 30. Component to Judge Applicants and Members. Each component shall be the sole judge of the qualifications of applicants for membership, and of its members.

The executive director shall cause to be published in The JOURNAL of the Association an official notice of the time and place of each Session, and shall also send each delegate and alternate a copy of such notice, together with official credentials, as soon as practicable after each such delegate and alternate has been officially certified, but not less than 10 days before the opening of such session. The speaker and executive director shall jointly determine all unfinished business from an earlier meeting as well as all known new business to come before the House. All such business shall be itemized and included in the notice of meeting. Section 20. Composition; Terms. The House shall be composed of the officially certified delegates of each component society, together with a speaker of the house. The current president, president-elect, vice president, WDA JOURNAL editor, treasurer, trustees and specialty group presidents shall be ex-officio members of the House without the right to vote. The ex-officio members of the House shall have access to the floor of the House, with the approval of the House. The number of delegates to which each component society is entitled for meetings of the House in any year shall be based upon the number of its members as of the 31st day of December of the preceding year. Each component society may select from among its active, life and retired members, the number of delegates to which it is entitled. Each component society may further select from its active, life and retired members the same number of members to serve as alternate delegates. Section 30. Eligibility. Members currently in good standing in this Association, except affiliate, honorary, dental hygienist and associate members, shall be eligible for election to the House. No voting member of the Board of Trustees shall be eligible to serve in the House. Section 40. Representation. Each component society shall be entitled to a delegate and an alternate for every 50 members, or major fraction thereof, in good standing, provided, however that each such society shall be entitled to at least one delegate. The MUSOD student body shall be entitled to two delegates and two alternates as defined in Section 50 below. Section 50. Representation Rules. Each component society shall annually certify and submit the names of its delegates and alternate delegates to the executive director of the Association at least 90 days prior to 2014 WDA Sourcebook

WDA Bylaws any meeting of the House. The MUSOD student body shall submit names of its delegates and alternates to the Executive Director of the Association at least 60 days prior to any meeting of the House.

The remaining nominees receiving the highest number of votes shall be elected alternates progressively until the quota is filled. The president of this Association at the time of the Annual Session of the American Dental Association shall automatically be a delegate.

Prior to such meeting of the House, the executive director shall prepare and have printed a list of the delegates and alternates elected by the Component Societies and MUSOD student body. In case any society shall elect more than its allotted number of delegates, the executive director, in preparing the list, shall drop one or more names, as directed by the secretary of the component society, until the proper number of names remain.

The president-elect of this Association at the time of the Annual Session of the American Dental Association shall automatically be a delegate and shall serve as the chairman of the Association delegation. The vice president of this Association at the time of the Annual Session of the American Dental Association shall be an automatic delegate.

The MUSOD delegates and alternates shall be members of the American Student Dental Association and selected by the MUSOD student body to serve a one-year term. The students selected as delegates shall be a D3 or D4 engaged in clinical training and the students selected as alternates shall be from the D2 or D1 class at the time of such House meeting.

WDA Bylaws

All students shall be student members of the Association. The students seated in the House should rotate sequentially through the trustee regions. The credentials of a delegate having been accepted and the delegate’s name placed on the roll of the House, he or she shall remain the duly accredited delegate of the trustee region represented until final adjournment of the meeting, provided that when an accredited delegate finds it impossible to continue service, a regularly selected alternate may be seated. Section 60. Vacancies. In the event a component society is unable to fill their delegate allotment, the seats may be filled by alternate delegates from other component societies within their region. If all alternate delegates have been assigned and a vacancy still occurs, the trustees from the region may appoint an active, life or retired member from any component society within their region to serve in the House in order to achieve a full delegation. Section 70. Powers and Duties. Powers. The House shall be empowered to: A. Determine the legislative policies of this Association. It may act upon resolutions submitted by component societies or by not less than five active members. B. Enact, amend, or repeal the Bylaws of the Association as provided in Chapter XIII hereof. C. Grant, amend, or revoke charters of component societies. D. Elect honorary members. E. Create Special committees. F. Approve memorials in the name of the Association. G. Adopt or amend the annual budget for the ensuing year proposed by the Board of Trustees. H. Establish the annual dues for all classes of dues paying members. Duties. A. Prepare and submit a list of nominees for the elective officers as provided in Chapter V, Section 30, of these Bylaws. B. Elect members of the Board of Trustees to the extent authorized by Chapter IV, Section 40, of these Bylaws. C. Elect a committee of five as the Bylaws Committee. D. Elect delegates and alternates to the Annual Session of the American Dental Association. Each trustee region, with the exception of the MUSoD Student region, shall be entitled to one delegate determined by their caucus. In addition, each of the five trustee regions shall be entitled to submit two nominees for the remaining delegate and alternate positions after which additional nominations may be made from the floor. The nominee receiving the highest number of votes shall serve as delegate.

2014 WDA Sourcebook

The Dean of Marquette University School of Dentistry shall be an automatic alternate. Should a delegate member of the delegation need to drop out for whatever reason, the selection of the alternate delegate to replace that person as a delegate will be as follows: • If the delegate was an automatic appointment due to serving as an officer of the association, the highest vote getting alternate delegate will fill the vacancy. • If the delegate was elected to serve as a regional representative then the highest vote getting alternate delegate from that region will become a delegate. If there is not an alternate delegate from that region serving, the highest vote getting alternate delegate will fill the vacancy. • If the delegate was not serving as a regional representative then the highest vote getting alternate delegate will fill the vacancy. If an alternate delegate is no longer able to attend, the vacancy will not be filled. E. Propose a trustee for the trustee district of the American Dental Association in which Wisconsin is included at such times as the Association shall be entitled, by tradition, to make such a proposal. F. Elect a speaker of the House during the last session of the House, who will then assume the duties of speaker at the close of business, or when a vacancy occurs. G. Elect the officers and editor of the Association. H. Elect an Ethics and Dental Relations Committee. I. Elect a Nominating Committee as outlined in Section 80 of this Chapter III. Section 80. House Committees. The election of the Bylaws, Ethics and Dental Relations, and Nominating Committee shall occur at the House. The composition of committee members, vacancies, and duties of each committee shall be as outlined in this Section. Student members are not eligible for election to these committees but may be advisory members. A. Bylaws 1. Composition. The committee shall be composed of five at-large members elected by the House to serve a term of five years. No member may serve more than two full five-year terms. The committee shall annually elect the chairman. 2. Vacancy. In the event of a vacancy, the president shall fill such a vacancy by appointment until a successor is elected at the next meeting of the House. 3. Duties. (1) Draft or approve the proposed text of all amendments to the WDA Bylaws prior to their submission to the House for action; (2) consider other matters referred to it, to hold hearings thereon, and to report its findings and recommendations to the House. B. Ethics and Dental Relations. 1. Composition. The committee shall be composed of nine members; five members shall be elected by the trustee regions (one from each trustee region) for terms of three years on a rotating basis, their election confirmed by the House; three members shall be elected by the House as at-large members for terms of three (3) years. One member shall be appointed by the president on an annual basis. Such elections shall insofar as possible provide representation for all segments of the profession; the chairman shall be appointed by the president from among the committee members.

WDA Bylaws 2. Vacancy. In the event of a vacancy, the president shall fill such vacancy by appointment from the trustee region involved until a successor is elected at the next House meeting. In the event a nominee for the position cannot be furnished by the trustee region, the president shall appoint an at-large member. If the vacancy occurs in an at-large position, an at-large appointment shall be made by the president to fill such vacancy until a successor is elected at the next Board of Trustees meeting. 3. Duties. The committee shall consider appeals made from the action or lack of action of the charges described in Chapter I, Section 40, of these Bylaws, and shall report its decision in such cases to the Board of Trustees. C. Nominating. 1. Composition. The committee shall be composed of five members and five alternates, a member and an alternate from Regions 1 through 5 of this Association. The chairmanship shall be rotated by trustee region in numerical order. The time and location of the meeting shall be at the discretion of the chairman.

3. Duties. This committee, with a member or alternate from each trustee region, shall meet to formulate a list of nominees for the elective offices of the Association as well as the speaker of the house. A report announcing the candidates shall be published to the membership as soon as possible after the meeting. Biographies and data that will be helpful in determining the adequacy of each candidate shall be published to the membership at least 30 days prior to the meeting of the House. Section 90. Special Session. A special session of the House shall be called by the president to consider only such business as shall be mentioned in the call, on a three-fourths affirmative vote of the members of the Board of Trustees present and voting in a regular or special meeting, or on written request of one-fifth of the officially certified delegates who comprised the last House, provided such request shall be made by at least one delegate each from not less than one-fifth of the component societies. The time and place of any special session of the House shall be determined by the president, provided the time selected shall be not for more than 45 days after the date the vote was taken or the request received. The executive director shall send an official notice of the time and place of each special session and a statement of the business to be considered to every officially certified delegate and alternate of the then current House, not less than 3030 days before the opening meeting of any such session.

B. Secretary. The secretary of the House shall serve as its recording officer and as custodian of its records. The secretary shall utilize an accepted method to obtain a record of proceedings, which shall serve as the official transactions of the House. The speaker shall appoint a secretary of the House in the absence of the executive director. Section 120. Order of Business; Annual Business Session. Unless changed by a two-thirds affirmative of the House, the order of business for meetings shall be determined by the speaker and secretary of the House. Section 130. Standing Rules. A. Reports. All reports of elective officers, the Board of Trustees, and committees, except supplemental reports, shall be published under the direction of the president and executive director of the Association, and shall be sent to each delegate and alternate at least 14 days in advance of the House. B. Introduction of New Business. New business must be introduced at the beginning of each House session. Action on any subsequent new business introduced after the beginning of the meeting of the House shall require unanimous vote for adoption. Section 140. Reference Committees. The speaker shall appoint reference committees as may be necessary to carry on the work of the House. Each committee shall be composed of not fewer than three members. Each committee chairman shall be a member of the House.

CHAPTER IV - BOARD OF TRUSTEES Section 10. Composition. The Board of Trustees shall consist of three trustees from each trustee region with the exception of the Student region, which shall consist of one trustee. The immediate past president, the president-elect, the vice president, the treasurer, the editor of the JOURNAL of the Association, and the executive director shall be ex-officio members of the Board of Trustees without the right to vote. Section 20. Qualifications. A member in good standing in this Association, an active member and actively engaged in practice or is a full-time faculty member or a state public health dentist member, a student member in good standing in this Association as well as the Marquette University School of Dentistry ASDA chapter may serve as trustee.

Section 100. Quorum. One-half of the voting members of the House shall constitute a quorum for the transaction of business at any meeting of any session.

A trustee must be a full-privileged member of one of the component societies that compose the trustee region from which elected. Should the status of any trustee change in regard to the preceding qualifications during the term of office that office shall thereupon be declared vacant and the president shall proceed promptly to fill such vacancy as provided in Section 60 of this Chapter.

Section 110. Officers of the House. The officers of the House shall be a speaker and a secretary. The executive director shall serve as secretary of the House.

The absence of a trustee from a meeting of the Board of Trustees shall not in itself constitute a vacancy.

A. Speaker. 1. Duties. The speaker shall preside over all meetings of the House, cast the deciding vote in case of a tie, appoint judges and tellers to assist in determining the results of any action taken by ballot, and perform such other duties as custom and parliamentary usage may require. The speaker shall be invited to attend all meetings of the Board of Trustees. 2. Eligibility. The speaker must be an active, life or retired member of this Association, but need not be a member of the House. 3. Terms. The speaker shall be eligible to serve such number of consecutive one-year terms to which he/she shall be elected.

WDA Bylaws

2. Vacancy. In the event of a vacancy, the alternate shall fill the vacancy for the trustee region position. In the event that both the member and alternate positions are vacant, the president shall fill such vacancy by appointment of a successor from the trustee region involved.

If a vacancy occurs in the speaker position, the office of speaker shall be filled temporarily by the president of the Association. The president shall preside over the first House session to be held after such vacancy, at which time the first order of business for the delegates shall be to elect a replacement speaker for whichever is applicable of (i) any remainder of the unexpired term during which the vacancy occurred, or (ii) a full one-year term.

Section 30. Term. Except as provided for in Section 40 hereinafter, a trustee is eligible to serve two (2) consecutive three (3) year terms. The student trustee is eligible to serve a maximum of three (3) one-year terms. Section 40. Elections. In a year in which a term expires, the members of a trustee region may elect the trustee at a qualifying meeting, annual or otherwise, of the trustee region, or by ballot. In order to constitute a qualifying meeting for purposes of this Section 40, the meeting must be held in accordance with the requirements of the bylaws of the region for constituting a meeting for the conduct of business of the region or, in the absence of any such region bylaw, at a 2014 WDA Sourcebook

WDA Bylaws

WDA Bylaws meeting (i) chaired by at least one (1) of the then sitting trustees for the region, (ii) duly noticed to all WDA members eligible to vote within the region at least 30, but not more than 60, days in advance by email, regular mail, official WDA publication, or any combination of the same, and (iii) having at least one-third of the members required to have received notice in attendance. The result of such election shall be certified to the executive director, who shall transmit this information to the House. The candidate receiving the majority of votes shall be declared elected. In no case shall a trustee be elected to serve more than two (2) consecutive full three year terms, unless no new qualified candidate, as determined pursuant to Section 20 hereof, runs and is elected to fill such office, in which case a trustee may be elected to an additional full three year term. Election to fulfill an unexpired term does not preclude serving two full three year terms.

D. Provide for and superintend the issuance of all publications of the Association, including proceedings, transaction and memoirs.

A trustee region may divide its trustees into different classes and the term of office of the several classes shall be staggered so that one trustee from that region shall be subject to election each year.

I. Fix the period, compensation, and other terms of the employment of agent of the Association.

A trustee region may elect trustees to terms of less than three years in order to provide for such staggering of terms, and election to such partial term does not preclude serving two full three year terms. No more than one trustee from a component may serve on the Board at the same time when the region they represent is part of a multi-component region unless all other components decline to put forth a candidate. The student trustee shall be elected in accordance with Marquette University School of Dentistry ASDA bylaws. Section 50. Installation. A trustee shall take office at the first Board of Trustees meeting held following installation by the House, or the transmission of the certificate of election from the designated trustee region to the House. Section 60. Vacancy. In the event of a vacancy in the Board of Trustees, the Region delegation may choose to select an interim trustee from their region during their caucus at the House of Delegates meeting. In the event the House of Delegates is not in session when the vacancy occurs or the Region is unable to make the selection during their caucus, the president shall appoint an interim trustee who is a qualified member of the trustee region in which the vacancy occurs. The executive director of the Association shall then follow the trustee election protocol established by the Board of Trustees to fill the trustee position for the remainder of the unexpired term. Section 70. Powers and Duties. Powers. The Board of Trustees shall have the authority consistent with its responsibilities. This shall include the power to: A. Serve as the managing body of the Association, and, as such, vested with power to conduct all business of the Association, subject to these Bylaws and such basic policies as are promulgated by the House. B. Direct the president to call special sessions of the House, as provided in Chapter III, Section 90, of these Bylaws. C. Nominate to the House candidates for honorary membership in this Association. D. Establish interim policies when the House is not in session and when such policies are essential to the management of the Association or are of an emergency nature, provided that all such policies must be presented for review at the next session of the House. E. Annually elect members to the Finance Committee. Duties. It shall be the duty of the Board of Trustees to: A. Provide such headquarters for the Association as may be required to conduct its business properly. Provide for the maintenance and supervision of the Executive Office and all other property or offices owned or operated by this Association. B. Appoint an executive director who need not be a dentist. C. Elect a treasurer who shall be a member in good standing.

2014 WDA Sourcebook

E. Determine the time and place for convening each Annual Scientific Session of the Association as well as the House meetings. F. Require any officer, agent or employee, who is entrusted with or has access to Association funds, to be bonded by a surety company in an amount deemed prudently necessary. G. Have all Association accounts audited at least annually by an experienced accountant. H. Review and act on all investments of the WDA.

J. Direct the trustees to act as the organizers and arbiters for the designated trustee region. The trustees shall hold a regional meeting annually for the purpose of conducting business of the trustee region; a trustee shall visit each component society in the trustee region once a year, inquiring into the condition of the profession and its component societies; and shall keep in touch with the activities of and aid in the betterment of the component societies of the trustee region. Each trustee shall make a report of activities and an evaluation of the condition of his or her trustee region at each meeting of the House. K. Nominate and elect members of the Board of Directors of WDA Insurance & Services Corp. L. Direct the president in voting the shares of stock of WDA Insurance & Services Corp. M. Act as the appellate body for the state Ethics and Dental Relations Committeeâ&#x20AC;&#x2122;s disciplinary proceedings. N. Develop goals and objectives for the Association; aid committees and members in accomplishing objectives; and maintain current data on public and professional attitudes toward dentistry and dental services. O. Confirm the ADA 9th District Trustee-elect candidate elected by the Michigan Dental Association. Section 80. Meetings. A. The Board of Trustees shall hold meetings as necessary, subject to the call of the president, or on petition of five trustees. B. Meetings of the Board of Trustees or committees may be conducted by telephone or by other communication technology in accordance with Section 181.0820 of the Wisconsin Non-stock Corporation law (or any successor statutory provision). C. Any action required or permitted to be taken at a Board of Trustees meeting may be taken (i) at a face-to-face meeting, (ii) at a meeting held pursuant to Section 181.0820 at the Wisconsin Non-Stock Corporation law (or any successor statutory provision) in accordance with normal Board procedures, or (iii) otherwise by written action signed by two-thirds of the Trustees then in office. Committees meeting in accordance with Section 181.0820 may act at such meetings pursuant to their normal meeting procedures. Section 90. Quorum. Nine voting members of the Board of Trustees shall constitute a quorum for the transaction of business at any meeting. Section 100. Committees. The Board of Trustees may establish: A. Executive Committee. To consist of the president, president-elect, vice president, treasurer, immediate past president, five trustees, one from each trustee region, elected for a one year term by the Board of Trustees, and the executive director, ex-officio. The treasurer, immediate past president and executive director shall have no vote. The Executive Committee shall have the full powers of the Board of Trustees to act between sessions of the latter on all matters except those specifically reserved by the Board of Trustees and those which would be contrary to its established policies. The Executive Committee shall report its activities at each meeting of the Board of Trustees.

WDA Bylaws B. Finance Committee. The committee selection shall be determined annually by the Board of Trustees. The chairman shall be appointed by the Board. In the event of a vacancy, the Board shall fill such vacancy by appointment of a successor. The Treasurer shall automatically be a member of the committee. The committee shall prepare a recommended budget for consideration by the Board of Trustees and for transmission to the House. Such budget shall be prepared for the Association for each ensuing fiscal year, copies to be distributed to each member of the House 30 days prior to the first meeting of the annual session; monitor Association investments; and survey and evaluate the performance of any service employed to handle the investing of the Association’s Reserve Fund. C. Long-Range Planning Committee. The committee shall consist of the president, presidentelect, immediate past president, vice president, treasurer, editor and five trustees, one from each trustee region, elected for a one-year term by the Board of Trustees. The vice president serves as chairman.

As needed, a strategic planning session with a professional facilitator will be conducted to include the committee, student trustee, speaker of the House, standing committee chairmen, and other individuals as appointed by the president. D. Editorial Advisory Board. The Editor shall be editor-in-chief of the JOURNAL of the Association, and is the head of the Editorial Advisory Board. The executive director shall be the executive editor and is a non-voting ex-officio member of the Editorial Advisory Board. EAB members provide the dentist and grassroots perspective for WDA print and electronic publications. Section 110. Officers. A. Titles. The officers of the Board of Trustees shall be a chairman and a secretary. The president of this Association shall serve as chairman and the executive director shall serve as secretary. In the absence of the president, the office of chairman shall be filled by the vice president, and in the absence of the vice president, a voting member of the Board of Trustees shall be elected to serve as a chairman pro tem. In the absence of the secretary, the chairman shall appoint a secretary pro tem. B. Duties. 1. Chairman. The chairman shall preside at all meetings of the Board of Trustees, cast the deciding vote in the case of a tie, and perform such other duties as custom and parliamentary usage require. The chairman may utilize the counsel and advice of a parliamentarian when a question of order arises, provided the decision of the chairman will be final unless an appeal from such decision is made by a member of the Board of Trustees, in which case final decision shall be by a majority vote of the trustees present and voting. 2. Secretary. The secretary shall serve as the recording secretary of the Board of Trustees and as the custodian of its records. The secretary may utilize the services of a professional recorder for the purpose of obtaining a stenographic record of the proceedings of the Board of Trustees, and shall cause a factual summary of such proceedings to be edited and published in its official transactions. Section 120. Trustee Regions. The trustee regions of this Association shall bear the following numbers and be comprised of the following Wisconsin counties: Region 1 – Northwest Ashland, Barron, Bayfield, Burnett, Chippewa, Clark, Douglas, Dunn, Eau Claire, Florence, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Pierce, Polk, Portage, Price, Rusk, St. Croix, Sawyer, Taylor, Vilas, Washburn and Wood.

Region 3 – Greater Milwaukee Milwaukee Region 4 – Southeast Ozaukee, Kenosha, Racine, Rock, Walworth, Washington and Waukesha Region 5 – Southwest Adams, Buffalo, Columbia, Crawford, Dane, Dodge, Grant, Green, Iowa, Jackson, Jefferson, Juneau, lacrosse, Lafayette, Marquette, Monroe, Pepin, Richland, Sauk, Trempealeau and Vernon Region 6 – Student Region Marquette University School of Dentistry ASDA Chapter Section 130. Trustee Region Changes. A component society may change to another trustee region by securing an amendment to Section 120 of this Chapter of the Bylaws.

CHAPTER V - ELECTIVE OFFICES Section 10. Titles. The elective offices of this Association shall be: president, president-elect, vice president and editor.

WDA Bylaws

The committee shall monitor outcomes and measurements of program activity, make recommendations each year to the Board of Trustees on new programs to implement, programs to sunset, and program prioritizations within the strategic plan. Additionally the committee will periodically review the Association’s governance and committee structure and perform other duties as deemed necessary.

Region 2 – Northeast Brown, Calumet, Door, Fond du Lac, Green Lake, Kewaunee, Manitowoc, Marinette, Oconto, Outagamie, Shawano, Sheboygan, Waupaca, Waushara and Winnebago.

Section 20. Eligibility. Members currently in good standing in this Association except affiliate, honorary, student, associate and dental hygienist members, shall be eligible to serve as elective officers. Section 30. Nominations. Nominations for elective offices shall be presented to the House by the Nominating Committee pursuant to Chapter III, Section 80, Subsection C. Nominations may also be made during the House session prior to the election of such offices except for any office with an automatic succession. Section 40. Elections. The election of officers shall be held annually at the House. Where more than one nomination is received, election shall be by ballot, and a majority of the votes cast shall be necessary to elect. In case no nominee receives a majority of the votes on the first ballot, the name of the nominee receiving the lowest number of votes shall be dropped from the ballot and a new ballot taken. This procedure shall be continued until one of the nominees receives a majority of all votes cast, whereupon the nominee shall be declared elected. Additional nominations may be made from the floor at either session by members of the House. Section 50. Term of Offices. The term of office for the president, president-elect, and vice-president shall be one year. The term of the Editor shall be four years. Terms shall begin upon the adjournment of the session at which officers are elected, or succeed to an office and shall continue until their successors have been elected and qualified. Section 60. Vacancies. In the event the office of president becomes vacant, the vice president shall become president for the unexpired portion of the term. A vacancy in the office of any of the remaining elective officers shall be filled by a majority vote of the Board of Trustees. In the event the office of president-elect becomes vacant between sessions of the House, the office of president for the ensuing year shall be filled at the next House or special meeting of the membership in the same manner as that provided for the nomination and election of elective officers, except that the nominee shall be described as “president for the ensuing year,” and shall immediately assume office. In such event, the office of president-elect shall be filled in the usual manner. In the event the office of the editor becomes vacant, the president shall appoint a member to fill the position until an election is held by the House. 2014 WDA Sourcebook

WDA Bylaws

WDA Bylaws Section 70. Duties. A. President. Shall preside at the Board of Trustees meetings and special meetings of the membership; call special meetings of the Board of Trustees as required or permitted elsewhere in these Bylaws; appoint members and fill vacancies to committees as specified in the WDA Bylaws; appoint special committees or representatives to outside agencies as required; participate in and report to the House and Board of Trustees; coordinate official communications and activities through the Executive office; write a column entitled “President’s Message” for the WDA Journal; supervise the utilization of legal and other consultants to the benefit of the WDA; represent the WDA to other professional groups and to the public; review and approve the expenses of the Treasurer; vote the shares of stock as directed by the Board of Trustees; and notify any “subject person,” as defined in Chapter XVII, of any actual or potential conflict of interest. Shall serve as ex-officio member of all committees; ex-officio, non-voting member of the House; shall serve as a delegate to the ADA Annual Session; and host for the visiting dignitaries attending the WDA House of Delegates Meeting. Shall appoint additional non-board members to participate with the Board of Trustees in formal strategic planning retreats. In the event of a vacancy in the speaker position, shall preside over the first House session following such vacancy for the purpose of overseeing the delegates’ election of a speaker. B. President-Elect. Shall automatically succeed to and assume the office of president at the next annual session installation of officers without other election; assist the president in the performance of duties and act as a WDA spokesperson at the direction of the president; serve as ex-officio member to all committees, other than those of the House and be a liaison to the Bylaws Committee and Nominating Committee. Shall serve as vice chairman of the Finance Committee; shall serve as Chairman of the WDA Delegation to the ADA Annual Session and shall fill vacancies to the delegation as outlined in Chapter III, Section 60; shall attend the ADA Annual Meeting as a delegate and attend the ADA Presidents-Elect Conference. Shall participate in and report to the House and the Board of Trustees at their meetings; coordinate Legislative Day; and make appointments to the committees during term as president. C. Vice President. Shall assist the president in the performance of duties; preside over meetings of the Board of Trustees and special meetings of the membership in the absence of the president; serve as a WDA spokesperson at the direction of the president and succeed to the office of president in case of vacancy for any cause. Shall serve as an ex-officio member of all committees and as a member of the Finance Committee. Shall participate in, as an ex-officio member, and report to the House and Board of Trustees meetings. Shall attend the ADA Annual Session as a delegate. D. Editor. Shall be the editor-in-chief of the JOURNAL of the Association and the WDA Sourcebook (member directory and practice guide), and, as such shall exercise editorial control over both publications subject to WDA policies.

CHAPTER VI - APPOINTIVE OFFICES Section 10. Titles. The appointed offices of this Association shall be the executive director and treasurer. Section 20. Appointments. The Board of Trustees shall elect the appointive officers by a majority vote. Section 30. Duties. The duties of the appointive officers shall include those enumerated in this section. A. Executive Director. The duties of this officer shall include: 1. Serving as chief operating officer of the Association. 2. Hiring, terminating and supervising all employees for positions created by the Board of Trustees. 3. Supervising and coordinating the activities of all committees, and assisting in the preparation of all reports of such committees. 4. Sending all notices and keeping records of proceedings of the House, the Board of Trustees and of all committees. 5. Acting as custodian of the seal, records, books, and papers of the Board of Trustees

2014 WDA Sourcebook

and the House, and of all other documents and property belonging to the Association, unless otherwise specifically provided for. 6. Performing all other duties prescribed for the office by these Bylaws, or by the House or Board of Trustees. 7. Submitting an annual written report of the activities of the office to the Board of Trustees and the House. 8. Furnishing a bond in an amount designated by the Board of Trustees before entering upon the above duties. 9. Acting as executive editor of the JOURNAL of the Association. 10. Serving without vote as an ex-officio member of the House, the Board of Trustees, and of all committees. 11. Advising trustees of required elections to fill specific positions of their trustee regions on the Board of Trustees and committees of the Wisconsin Dental Association. 12. The Executive Director shall serve as Secretary of the Association. B. Treasurer. Shall pay out all monies belonging to the Association on written order of the executive director; furnish surety bond in the amount required by the Board of Trustees before entering upon duties; review and approve payment of expenses of WDA officers and report on Association financial activities at each meeting of the Board of Trustees and House. Shall serve as a member of the Finance Committee and as an ex-officio member of the House and Board, without the right to vote. The treasurer is eligible to serve unlimited three (3) year terms.

CHAPTER VII - COMMITEES Section 10. Eligibility. All voting members of all committees, including their chairmen, must be members in good standing in the Association at the time of their appointment or election, and must maintain such standing during their tenure on the committee. Section 20. Quorum. A majority of the voting members of any committee shall constitute a quorum for the transaction of business. Section 30. Committee Reports. Each Ad Hoc committee, as well as the committees of the House, shall submit an annual written report to the House through and within the time fixed by the executive director’s office, together with any other reports which may be requested by the House or the Board of Trustees. In addition, each Ad Hoc committee, as well as the committees of the House, shall report directly on actions and conclusions to the Board of Trustees and/or the House on request. Section 40. Committee Privileges. By invitation, chairmen and members of all committees who are not members of the House or Board of Trustees may present reports in person to either body, and participate in the debate thereon, but shall not have the right to vote. Section 50. Duties. Each committee shall perform those duties respectively assigned to it by the House or the Board of Trustees. Section 60. Liaison. All officers shall serve in an ex-officio capacity to the committees of this Association, and trustees shall be appointed to serve as liaison to specific committees on behalf of the Board of Trustees.

CHAPTER VIII - SCIENTIFIC SESSION Section 10. Object. The scientific session of this Association is established to foster the presentation and discussion of subjects pertaining to the science and art of dentistry.

WDA Bylaws Section 20. Time and Place. A scientific session shall be held annually at a time and place selected by the Board of Trustees. Such selection shall, if practical, be made at least one year in advance. The selected time and place for holding any session may be changed, if necessary, by a three-fourths vote of the voting members of the Board, and such change shall be made at least 60 days prior to the time selected for the session. Section 30. Management and General Arrangements. The Committee on the Annual Session shall provide for the management of, and make all arrangements for, each scientific session not otherwise provided for in these Bylaws, subject to review by the Board of Trustees. Section 40. Commercial Exhibits. Products of the dental supply trade and laboratories, and other products, may be exhibited at each Annual Scientific Session under the direction of the Committee on the Annual Session, subject to review by the Board of Trustees.

CHAPTER IX - SPECIAL MEETINGS OF THE MEMBERSHIP Section 10. Quorum. A quorum for a special meeting of the membership shall consist of 20 percent of the then current membership. Section 20. Powers. The membership at a special meeting shall have the power to consider and act upon appropriate matters other than those set forth in Chapter III and IV of the Bylaws relating to the powers, duties, structure and proceedings of the House and the Board of Trustees respectively. Section 30. Meetings. A special meeting of the membership may be called by the president or by a petition signed by 10 percent of the voting members. The petition must be signed by at least three members from each trustee region with no more than one-third of the petitioners being members of any one trustee region. The purpose of the special meeting of the membership is to consider such business as shall be noticed in the call, and is elsewhere authorized in these Bylaws. The time and place of any such meeting shall be determined by the president, and notice thereof shall be given to all members not less than 30 days prior to the date fixed for such meeting.

Members shall have two options in remitting tripartite dues: (1) payment in full no later than March 31 of the current year; (2) payment in six equal installments, due Dec. 15 preceding the dues year, Jan. 15, Feb. 15, March 15, April 15 and May 15 of the current year. Partial payments of dues are not refundable. Section 20. Fiscal Year. The fiscal year of this Association shall begin Jan. 1 and end Dec. 31. Section 30. General Fund. The general fund shall consist of all moneys received, other than those specifically allocated to other funds in these Bylaws. This fund shall be used for defraying all expenses incurred by this Association not otherwise specifically allocated by these Bylaws, or by appropriate action of the House or Board of Trustees.

CHAPTER XII - INDEMNIFICATION OF OFFICERS, TRUSTEES, EMPLOYEES, AGENTS AND COMMITTEE MEMBERS A. This Association shall indemnify any person who was or is a party, or who was or is threatened to be made a party to any threatened, pending or completed action, suit or proceeding, whether civil, criminal administrative or investigative, and whether with or without merit (other than an action by or in the rights of the Association) by reason of the fact that he or she is or was a trustee, director, officer, employee, or agent of the Association or a member of any committee of the Association operating pursuant to the Bylaws of the Association or established by The Association against expenses, including attorneys’ fees, judgment, fines, and amount paid in settlement actually and reasonably incurred in connection with such action, suit or proceeding, either before or after such action, suit or proceeding is commenced, if he or she acted in good faith and in a manner he or she had reasonable cause to believe was in or not opposed to the best interests of the Association, and, with respect to any criminal action or proceeding, had no reasonable cause to believe the conduct was unlawful. The termination of any action, suit or proceeding by judgment, order, settlement, conviction, or upon a plea of nolo contendere or its equivalent, shall not, of itself, create a presumption that the person did not act in good faith and in a manner which he or she had reasonable cause to believe was in or not opposed to the best interests of the Association, and, with respect to any criminal action or proceeding, had reasonable cause to believe that the conduct was unlawful.

CHAPTER XI - FINANCES

B. This Association shall indemnify any person who was or is a party or who was or is threatened to be made a party to any threatened, pending, or completed action or suit, whether with or without merit, by or in the right of the Association to procure a judgment in its favor by reason of the fact that he or she is or was a trustee, director, officer, employee or agent of the Association, or a member of any committee of the Association operating pursuant to the Bylaws of the Association or established by the Association against expenses, including attorneys’ fees, actually and reasonably incurred in connection with the defense or settlement of such action or suit, either before or after such action or suit is commenced, if he or she acted in good faith and in a manner he or she had reasonable cause to believe was in or not opposed to the best interests of the Association except that no indemnification shall be made in respect of any claim, issue, or matter as to which such person shall have been adjudged to be liable for negligence or misconduct in the performance of duty to the Association unless and only to the extent that the court in which such action or suit was brought or another court of competent jurisdiction shall determine upon application that, despite the adjudication of liability but in view of all the circumstances of the case, such person is fairly and reasonably entitled to indemnify for such expenses as such court shall deem proper.

Section 10. Membership Dues. The annual dues of this Association plus the current dues of the American Dental Association and the individual component society shall be due on Jan. 1 of each year. At the option of the component dental society, the total amount of these tripartite dues may be payable to this Association. The Association shall remit the requisite amount due to the American Dental

C. To the extent that a trustee, director, officer, employee, agent, committee member has been successful on their merits or otherwise in defense of any action, suit, or proceeding referred to in A or B of this Chapter XII, or in defense of any claim, issue or matter therein, he or she shall be indemnified against expenses, including attorneys’ fees, actually and reasonably incurred in connection therewith.

Section 40. Voting. Each active, life, retired, full-time faculty and state public health dentist member in actual attendance at any special meeting of the membership shall be entitled to vote on each matter presented. Members not in actual attendance at a meeting shall not be permitted to vote by proxy or any other means.

CHAPTER X - PUBLICATIONS Section 10. Official Journal. This Association shall publish or cause to be published an official journal under the title of The JOURNAL of the Wisconsin Dental Association (commonly referred to as the WDA Journal). The Board of Trustees shall determine its size and the frequency of publication.

2014 WDA Sourcebook

WDA Bylaws

Section 50. Admission. Admission to meetings of the scientific session shall be limited to members of this Association who are in good standing, and to others invited in accordance with rules and regulations established by the Committee on the Annual Session, subject to review by the Board of Trustees.

Association on a monthly basis and shall remit the requisite amount due to each component society on the first day of February, May, August and November with any remaining dues collected paid prior to the end of the dues paying year.

WDA Bylaws

D. Any indemnification under A or B of this Chapter XII (unless ordered by a court) shall be made by the Association only as authorized in the specific case upon a determination that indemnification of the trustee, director, officer, employee, agent, committee member is proper in the circumstances because of meeting the applicable standard of conduct set forth in A or B of this Chapter XII. Such determinations shall be made (a) by the Board of Trustees by a majority vote of a quorum consisting of trustees who were not parties to such action, suit or proceeding or (b) if such a quorum is not obtainable, or, even if obtainable, a quorum of disinterested trustees so directs, by independent legal counsel in a written opinion, or (c) by the House. E. Expense, including attorneys’ fees, incurred by a trustee, director, officer, employee, agent, committee member in defending any action, suit or proceeding, whether civil, criminal, administrative or investigative, whether threatened, pending or completed, or whether by or in the right of the Association, may be paid by the Association prior to the time such person is made a formal party to any such action, suit or proceeding, or in advance of the final disposition of any such action, suit or proceeding. Authorization for payment of such expenses, including attorneys’ fees, shall be made (a) by the Board of Trustees by a majority vote of a quorum consisting of trustees who are or were not parties to any such action, suit or proceeding or (b) if such a quorum is not obtainable, or, even if obtainable, a quorum of disinterested trustees so directs, by written opinion of independent legal counsel that indemnification of such person is permissible, or (c) by the House upon receipt of an undertaking by or on behalf of such trustee, director, officer, employee, agent, committee members to repay such amount unless it shall ultimately be determined that such person is entitled to be indemnified by the Association as authorized in this Chapter XII. F. The indemnification provided by this Chapter XII shall not be deemed exclusive of any other rights to which an indemnified person may be entitled, as a matter of law, or under any agreement, by law, vote of members of disinterested trustees or otherwise, both as to action in an official capacity as a trustee, director, officer, employee, agent committee member, and as to action in another capacity while holding such office, and shall continue as to a person who has ceased to be a trustee, director, officer, employee, agent, committee member, or who has ceased to act in such other capacity and shall inure to the benefit of the heirs, executors, and administrators of such a person. G. This Association may purchase and maintain insurance on behalf of any person who is or was a trustee, director, officer, employee, or agent of the Association or a member of any committee of the Association operating pursuant to the Bylaws of the Association or established by the Association, or is or was serving at the request of by designation of the Association as a trustee, director, officer, employee, agent, or committee member or another association, corporation, partnership, joint venture, trust, or other enterprise against any liability asserted against and incurred by the individuals in any such capacity, or arising out of his or her status as such, whether or not the Association would have the power to indemnify the individual against such liability under the provisions of this Chapter XII.

CHAPTER XIII - AMENDMENTS These Bylaws may be amended at any meeting of the House by a two-thirds vote of the members present and voting.

2014 WDA Sourcebook

CHAPTER XIV - REFERENDUM The House or Board of Trustees may, by a two-thirds vote of those present and voting in whichever body initiates the action, order a mail referendum by all voting members on any question pending before the initiating body. A majority vote of the members who vote on the referendum question shall decide the issue.

CHAPTER XV - RULES OF ORDER The House, Board of Trustees, special meetings of the membership and all committees of the Association shall be governed by applicable and appropriate provision of American Institute of Parliamentarian’s Standard Code of Parliamentary Procedures, as from time to time revised, provided that any of the above may make its own rules of procedure to the extent that they are consistent with these Bylaws or with general law.

CHAPTER XVI - PRINCIPLES OF ETHICS The Principles of Ethics and Code of Professional Conduct of the American Dental Association shall be the principles of ethics of this Association. These basic Principles, together with Advisory Opinions issued by the American Dental Association and interpretations approved by this House, shall constitute the entire body of the Principles of Ethics for the Wisconsin Dental Association, and this instrument in its entirety shall be utilized at the component and State Association level for resolving all problems arising out of ethical violations.

CHAPTER XVII - CONFLICT OF INTEREST It is the policy of this Association that all individuals who serve as elective, appointive and employed offices and positions (“subject persons”) do so in a representative or fiduciary capacity requiring loyalty to the Association. At all times while serving in such offices and positions, subject persons shall further the interests of the Association as a whole. Subject persons have an absolute obligation to be sensitive to actual and potential conflicts of interest between their own interests and those of the Association. Whenever a subject person perceives the existence of an actual or potential conflict of interest, he or she shall fully disclose the same to the appropriate Association body and officials and shall remove himself or herself and shall refrain from all deliberations, discussions, and decisions relating to all subject topics. Subject persons whose actual and potential conflicts of interest reach a level of frequency or magnitude so as to impede their overall ability to continue to meet their obligations to the Association must resign or be removed from their elective, appointive or employed positions even after full disclosure. Any member who has been appointed to the Dentistry Examining Board, or its successor, shall be deemed to have an actual conflict of interest with the Board of Trustees and any committee that deals with state legislation or regulation governing the practice of dentistry, and shall not serve on any such entities so long as he or she is a member of the Dentistry Examining Board. Any member’s service as an elected member of any federal, state, county, municipal or other governmental body does not necessarily create a conflict with the interests of the Association.

WDA Code of Ethics I. INTRODUCTION

The dental profession holds a special position of trust within society. As a consequence, society affords the profession certain privileges that are not available to members of the public-at-large. In return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct. These standards are embodied in the ADA Principles of Ethics and Code of Professional Conduct (ADA Code). The ADA Code is, in effect, a written expression of the obligations arising from the implied contract between the dental profession and society. Members of the ADA voluntarily agree to abide by the ADA Code as a condition of membership in the Association. They recognize that continued public trust in the dental profession is based on the commitment of individual dentists to high ethical standards of conduct. The ADA Code has three main components: The Principles of Ethics, the Code of Professional Conduct and the Advisory Opinions.

The Code of Professional Conduct is an expression of specific types of conduct that are either required or prohibited. The Code of Professional Conduct is a product of the ADA’s legislative system. All elements of the Code of Professional Conduct result from resolutions that are adopted by the ADA’s House of Delegates. The Code of Professional Conduct is binding on members of the ADA, and violations may result in disciplinary action. The Advisory Opinions are interpretations that apply the Code of Professional Conduct to specific fact situations. They are adopted by the ADA’s Council on Ethics, Bylaws and Judicial Affairs to provide guidance to the membership on how the Council might interpret the Code of Professional Conduct in a disciplinary proceeding. The ADA Code is an evolving document and by its very nature cannot be a complete articulation of all ethical obligations. The ADA Code is the result of an ongoing dialogue between the dental profession and society, and as such, is subject to continuous review. Although ethics and the law are closely related, they are not the same. Ethical obligations may — and often do — exceed legal duties. In resolving any ethical problem not explicitly covered by the ADA Code, dentists should consider the ethical principles, the patient’s needs and interests, and any applicable laws.

II. PREAMBLE The American Dental Association calls upon dentists to follow high ethical standards which have the benefit of the patient as their primary goal. In recognition of this goal, the education and training of a dentist has resulted in society affording to the profession the privilege and obligation of self-government. To fulfill this privilege, these high ethical standards should be adopted and practiced throughout the dental school educational process and subsequent professional career.

The Association believes that dentists should possess not only knowledge, skill and technical competence but also those traits of character that foster adherence to ethical principles. Qualities of honesty, compassion, kindness, integrity, fairness and charity are part of the ethical education of a dentist and practice of dentistry and help to define the true professional. As such, each dentist should share in providing advocacy to and care of the underserved. It is urged that the dentist meet this goal, subject to individual circumstances.

III. PRINCIPLES, CODE OF PROFESSIONAL CONDUCT AND ADVISORY OPINIONS SECTION 1 PRINCIPLE: PATIENT AUTONOMY (“self-governance”). The dentist has a duty to respect the patient’s rights to self-determination and confidentiality.

CODE OF PROFESSIONAL CONDUCT 1.A. PATIENT INVOLVEMENT. The dentist should inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions. 1.B. PATIENT RECORDS. Dentists are obliged to safeguard the confidentiality of patient records. Dentists shall maintain patient records in a manner consistent with the protection of the welfare of the patient. Upon request of a patient or another dental practitioner, dentists shall provide any information in accordance with applicable law that will be beneficial for the future treatment of that patient. ADVISORY OPINIONS 1.B.1 FURNISHING COPIES OF RECORDS. A dentist has the ethical obligation on request of either the patient or the patient’s new dentist to furnish, in accordance with applicable law, either gratuitously or for nominal cost, such dental records or copies or summaries of them, including dental X-rays or copies of them, as will be beneficial for the future treatment of that patient. This obligation exists whether or not the patient’s account is paid in full. 1.B.2 CONFIDENTIALITY OF PATIENT RECORDS. The dominant theme in Code Section 1-B is the protection of the confidentiality of a patient’s records. The statement in this section that relevant information in the records should be released to another dental practitioner assumes that the dentist requesting the information is the patient’s present dentist. There may be circumstances where the former dentist has an ethical obligation to inform the present dentist of certain facts. Code Section 1-B assumes the dentist releasing relevant information is acting in accordance with applicable law. Dentists should be aware that the laws of the various jurisdictions in the United States are not uniform, and some confidentiality laws appear to prohibit the transfer of pertinent information, such as HIV seropositivity. Absent certain knowledge that the laws of the dentist’s jurisdiction permit the forwarding of this information, a dentist should obtain the patient’s written permission before forwarding health records which contain information of a sensitive nature, such as HIV seropositivity, chemical dependency or sexual preference. If it is necessary for a treating dentist to consult with another dentist or physician with respect to the patient, and the circumstances do not permit the patient to remain anonymous, the treating dentist should seek the permission of the patient prior to the release of data from the patients’ records to the consulting practitioner. If the patient refuses, the treating dentist should then contemplate obtaining legal advice regarding the termination of the dentist/patient relationship.

Code of Ethics

The Principles of Ethics are the aspirational goals of the profession. They provide guidance and offer justification for the Code of Professional Conduct and the Advisory Opinions. There are five fundamental principles that form the foundation of the ADA Code: Patient autonomy, nonmaleficence, beneficence, justice and veracity. Principles can overlap each other as well as compete with each other for priority. More than one principle can justify a given element of the Code of Professional Conduct. Principles may at times need to be balanced against each other, but, otherwise, they are the profession’s firm guideposts.

This principle expresses the concept that professionals have a duty to treat the patient according to the patient’s desires, within the bounds of accepted treatment, and to protect the patient’s confidentiality. Under this principle, the dentist’s primary obligations include involving patients in treatment decisions in a meaningful way, with due consideration being given to the patient’s needs, desires and abilities, and safeguarding the patient’s privacy.

SECTION 2 PRINCIPLE: NONMALEFICENCE (“do no harm”). The dentist has a duty to refrain from harming the patient. This principle expresses the concept that professionals have a duty to protect the patient from harm. Under this principle, the dentist’s primary obligations include keeping knowledge and skills current, knowing one’s own limitations and when to refer to a specialist or other professional, and knowing when and under what circumstances delegation of patient care to auxiliaries is appropriate. CODE OF PROFESSIONAL CONDUCT 2.A. EDUCATION. The privilege of dentists to be accorded professional status rests primarily in the knowledge, skill and experience with which they serve their patients and society. All dentists, therefore, have the obligation of keeping their knowledge and skill current.

2014 WDA Sourcebook

Code of Ethics 2.B. CONSULTATION AND REFERRAL. Dentists shall be obliged to seek consultation, if possible, whenever the welfare of patients will be safeguarded or advanced by utilizing those who have special skills, knowledge and experience. When patients visit or are referred to specialists or consulting dentists for consultation: 1. The specialists or consulting dentists upon completion of their care shall return the patient, unless the patient expressly reveals a different preference, to the referring dentist, or, if none, to the dentist of record for future care.

Code of Ethics

2. The specialists shall be obliged when there is no referring dentist and upon a completion of their treatment to inform patients when there is a need for future dental care. ADVISORY OPINION 2.B.1 SECOND OPINIONS. A dentist who has a patient referred by a third party* for a “second opinion” regarding a diagnosis or treatment plan recommended by the patient’s treating dentist should render the requested second opinion in accordance with this Code of Ethics. In the interest of the patient being afforded quality care, the dentist rendering the second opinion should not have a vested interest in the ensuing recommendation. *A third party is any party to a dental prepayment contract that may collect premiums, assume financial risks, pay claims and/or provide administrative services. 2.C. USE OF AUXILIARY PERSONNEL. Dentists shall be obliged to protect the health of their patients by only assigning to qualified auxiliaries those duties which can be legally delegated. Dentists shall be further obliged to prescribe and supervise the patient care provided by all auxiliary personnel working under their direction. 2.D. PERSONAL IMPAIRMENT. It is unethical for a dentist to practice while abusing controlled substances, alcohol or other chemical agents which impair the ability to practice. All dentists have an ethical obligation to urge chemically impaired colleagues to seek treatment. Dentists with firsthand knowledge that a colleague is practicing dentistry when so impaired have an ethical responsibility to report such evidence to the professional assistance committee of a dental society. ADVISORY OPINION 2.D.1. ABILITY TO PRACTICE. A dentist who contracts any disease or becomes impaired in any way that might endanger patients or dental staff shall, with consultation and advice from a qualified physician or other authority, limit the activities of practice to those areas that do not endanger patients or dental staff. A dentist who has been advised to limit the activities of his or her practice should monitor the aforementioned disease or impairment and make additional limitations to the activities of the dentist’s practice, as indicated. 2.E. POSTEXPOSURE, BLOODBORNE PATHOGENS. All dentists, regardless of their bloodborne pathogen status, have an ethical obligation to immediately inform any patient who may have been exposed to blood or other potentially infectious material in the dental office of the need for postexposure evaluation and follow-up and to immediately refer the patient to a qualified health care practitioner who can provide postexposure services. The dentist’s ethical obligation in the event of an exposure incident extends to providing information concerning the dentist’s own bloodborne pathogen status to the evaluating health care practitioner, if the dentist is the source individual, and to submitting to testing that will assist in the evaluation of the patient. If a staff member or other person is the source individual, the dentist should encourage that person to cooperate as needed for the patient’s evaluation. 2.F. PATIENT ABANDONMENT. Once a dentist has undertaken a course of treatment, the dentist should not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another dentist. Care should be taken that the patient’s oral health is not jeopardized in the process.

2014 WDA Sourcebook

2.G. PERSONAL RELATIONSHIPS WITH PATIENTS. Dentists should avoid interpersonal relationships that could impair their professional judgement or risk the possibility of exploiting the confidence placed in them by a patient. SECTION 3 PRINCIPLE: BENEFICENCE (“do good”). The dentist has a duty to promote the patient’s welfare. This principle expresses the concept that professionals have a duty to act for the benefit of others. Under this principle, the dentist’s primary obligation is service to the patient and the public-at-large. The most important aspect of this obligation is the competent and timely delivery of dental care within the bounds of clinical circumstances presented by the patient, with due consideration begin given to the needs, desires and values of the patient. The same ethical considerations apply whether the dentist engages in fee-for-service, managed care or some other practice arrangement. Dentists may choose to enter into contracts governing the provision of care to a group of patients; however, contract obligations do not excuse the dentists from their ethical duty to put the patient’s welfare first. CODE OF PROFESSIONAL CONDUCT 3.A. COMMUNITY SERVICE. Since dentists have an obligation to use their skills, knowledge and experience for the improvement of the dental health of the public and are encouraged to be leaders in their community, dentists in such service shall conduct themselves in such a manner as to maintain or elevate the esteem of the profession. 3.B. GOVERNMENT OF A PROFESSION. Every profession owes society the responsibility to regulate itself. Such regulation is achieved largely through the influence of the professional societies. All dentists, therefore, have the dual obligation of making themselves a part of a professional society and observing its rules of ethics. WDA Interpretation a. It is the duty of a member to abide by the decisions of committees duly constituted by the component society or by this Association pursuant to policies and guidelines for such committees approved by the House of Delegates or Board of Trustees of this Association and to comply with the reasonable requirements of such committees necessary or convenient to enable such committees to perform their functions. Any violation of such duty constitutes unethical conduct. 3.C. RESEARCH AND DEVELOPMENT. Dentists have the obligation of making the results and benefits of their investigative efforts available to all when they are useful in safeguarding or promoting the health of the public. 3.D. PATENTS AND COPYRIGHTS. Patents and copyrights may be secured by dentists provided that such patents and copyrights shall not be used to restrict research or practice. 3.E. ABUSE AND NEGLECT. Dentists shall be obliged to become familiar with the perioral signs of child abuse and to report suspected cases to the proper authorities consistent with state laws. ADVISORY OPINION 3.E.1. REPORTING ABUSE AND NEGLECT. The public and the profession are best served by dentists who are familiar with identifying the signs of abuse and neglect and knowledgeable about the appropriate intervention resources for all populations. A dentist’s ethical obligation to identify and report the signs of abuse and neglect is, at a minimum, to be consistent with a dentist’s legal obligation in the jurisdiction where the dentist practices. Dentists, therefore, are ethically obliged to identify and report suspected cases of abuse and neglect to the same extent as they are legally obliged to do so in the jurisdiction where they practice. Dentists have a concurrent ethical obligation to respect an adult patient’s right to self-determination and confidentiality

Code of Ethics and to promote the welfare of all patients. Care should be exercised to respect the wishes of an adult patient who asks that a suspected case of abuse and/or neglect not be reported, where such a report is not mandated by law. With the patient’s permission, other possible solutions may be sought. Dentists should be aware that jurisdictional laws vary in their definitions of abuse and neglect, in their reporting requirements and the extent to which immunity is granted to good faith reporters. The variances may raise potential legal and other risks that should be considered, while keeping in mind the duty to put the welfare of the patient first. Therefore a dentist’s ethical obligation to identify and report suspected cases of abuse and neglect can vary from one jurisdiction to another. Dentists are ethically obligated to keep current their knowledge of both identifying abuse and neglect and reporting it in the jurisdiction(s) where they practice.

ADVISORY OPINION 3. F.1. DISRUPTIVE BEHAVIOR IN THE WORKPLACE. Dentists are the leaders of the oral healthcare team. As such, their behavior in the workplace is instrumental in establishing and maintaining a practice environment that supports the mutual respect, good communication, and high levels of collaboration among team members required to optimize the quality of patient care provided. Dentists who engage in disruptive behavior in the workplace risk undermining professional relationships among team members, decreasing the quality of patient care provided, and undermining the public’s trust and confidence in the profession. SECTION 4 PRINCIPLE: JUSTICE (“fairness”). The dentist has a duty to treat people fairly. This principle expresses the concept that professionals have a duty to be fair in their dealings with patients, colleagues and society. Under this principle, the dentist’s primary obligations include dealing with people justly and delivering dental care without prejudice. In its broadest sense, this principle expresses the concept that the dental profession should actively seek allies throughout society on specific activities that will help improve access to care for all. CODE OF PROFESSIONAL CONDUCT 4.A. PATIENT SELECTION. While dentists, in serving the public, may exercise reasonable discretion in selecting patients for their practices, dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient’s race, creed, color, sex or national origin. ADVISORY OPINION 4.A.1. ADVISORY OPINION 4.A.1. PATIENTS WITH BLOODBORNE PATHOGENS. A dentist has the general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individual is infected with Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus or another bloodborne pathogen, based solely on that fact, is unethical. Decisions with regard to the type of dental treatment provided or referrals made or suggested should be made on the same basis as they are made with other patients. As is the case with all patients, the individual dentist should determine if he or she has the need of another’s skills, knowledge, equipment or experience. The dentist should also determine, after consultation with the patient’s physician, if apporopriate, if the patient’s health status would be significantly compromised by the provision of dental treatment. 4.B. EMERGENCY SERVICE. Dentists shall be obliged to make reasonable arrangements for the emergency care of their patients of record. Dentists shall be obliged when consulted in an emergency by patients not of record to make reasonable arrangements for emergency care. If treatment is provided, the dentist, upon completion of treatment, is obliged to return the patient to his or her regular dentist unless the patient expressly reveals a different preference.

ADVISORY OPINION 4.C.1. MEANING OF “JUSTIFIABLE.” Patients are dependent on the expertise of dentists to know their oral health status. Therefore, when informing a patient of the status of his or her oral health, the dentist should exercise care that the comments made are truthful, informed and justifiable. This should, if possible, involve consultation with the previous treating dentist(s), in accordance with applicable law, to determine under what circumstances and conditions the treatment was performed. A difference of opinion as to preferred treatment should not be communicated to the patient in a manner which would unjustly imply mistreatment. There will necessarily be cases where it will be difficult to determine whether the comments made are justifiable. Therefore, this section is phrased to address the discretion of dentists and advises against unknowing or unjustifiable disparaging statements against another dentist. However, it should be noted that, where comments are made which are not supportable and therefore unjustified, such comments can be the basis for the institution of a disciplinary proceeding against the dentist making such statements. WDA Interpretation It is the duty of each member to call to the attention of the state or component society, illegal, dishonest or unethical conduct on the part of any member of the dental profession. 4.D. EXPERT TESTIMONY. Dentists may provide expert testimony when that testimony is essential to a just and fair disposition of a judicial or administrative action.

Code of Ethics

3. F. PROFESSIONAL DEMEANOR IN THE WORKPLACE. Dentists have the obligation to provide a workplace environment that supports respectful and collaborative relationships for all those involved in oral health care.

4.C. JUSTIFIABLE CRITICISM. Dentists shall be obliged to report to the appropriate reviewing agency as determined by the local component or constituent society instances of gross or continual faulty treatment by other dentists. Patients should be informed of their present oral health status without disparaging comment about prior services. Dentists issuing a public statement with respect to the profession shall have a reasonable basis to believe that the comments made are true.

ADVISORY OPINION 4.D.1. CONTINGENT FEES. It is unethical for a dentist to agree to a fee contingent upon the favorable outcome of the litigation in exchange for testifying as a dental expert. 4.E. REBATES AND SPLIT FEES. Dentists shall not accept or tender “rebates” or “split fees.” ADVISORY OPINION 4.E.1. SPLIT FEES IN ADVERTISING AND MARKETING SERVICES. The prohibition against a dentist’s accepting or tendering rebates or split fees applies to business dealings between dentists and any third party, not just other dentists. Thus, a dentist who pays for advertising or marketing services by sharing a specified portion of the professional fees collected from prospective or actual patients with the vendor providing the advertising or marketing services is engaged in fee splitting. The prohibition against fee splitting is also applicable to the marketing of dental treatments or procedures via “social coupons” if the business arrangement between the dentist and the concern providing the marketing services for that treatment or those procedures allows the issuing company to collect the fee from the prospective patient, retain a defined percentage or portion of the revenue collected as payment for the coupon marketing service provided to the dentist and remit to the dentist the remainder of the amount collected. Dentists should also be aware that the laws or regulations in their jurisdictions may contain provisions that impact the division of revenue collected from prospective patients between a dentist and a third party to pay for advertising or marketing services. SECTION 5 PRINCIPLE: VERACITY (“truthfulness”). The dentist has a duty to communicate truthfully. This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist’s primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity. 2014 WDA Sourcebook

Code of Ethics CODE OF PROFESSIONAL CONDUCT 5.A. REPRESENTATION OF CARE. Dentists shall not represent the care being rendered to their patients in a false or misleading manner. ADVISORY OPINIONS 5.A.1. DENTAL AMALGAM AND OTHER RESOTRATIVE MATERIALS. Based on current scientific data, the ADA has determined that the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treament is performed solely at the recommendation or suggestion of the dentist, is improper and unethical. The same principle of veracity applies to the dentist’s recommendation comcerning the removal of any dental restorative material.

Code of Ethics

5.A.2. UNSUBSTANTIATED REPRESENTATIONS. A dentist who represents that dental treatment recommended or performed by the dentist has the capacity to cure or alleviate diseases, infections or other conditions, when such representations are not based upon accepted scientific knowledge or research, is acting unethically. 5.B. REPRESENTATION OF FEES. Dentists shall not represent the fees being charged for providing care in a false or misleading manner. ADVISORY OPINIONS 5.B.1. WAIVER OF COPAYMENT. A dentist who accepts a third party* payment under a copayment plan as payment in full without disclosing to the third party* that the patient’s payment portion will not be collected, is engaged in overbilling. The essence of this ethical impropriety is deception and misrepresentation; an overbilling dentist makes it appear to the third party* that the charge to the patient for services rendered is higher than it actually is. 5.B.2. OVERBILLING. It is unethical for a dentist to increase a fee to a patient solely because the patient is covered by a dental plan. 5.B.3. FEE DIFFERENTIAL. The fee for a patient without dental benefits shall be considered a dentist’s full fee.* This is the fee that should be represented to all benefit carriers regardless of any negotiated fee discount. Payments accepted by a dentist under a governmentally funded program, a component or constituent dental society-sponsored access program, or a participating agreement entered into under a program with a third party shall not be considered or construed as evidence of overbilling in determining whether a charge to a patient, or to another third party in behalf of a patient not covered under any of the aforecited programs constitutes overbilling under this section of the Code. * A full fee is the fee for a service that is set by the dentist, which reflects the costs of providing the procedure and the value of the dentist’s professional judgment. 5.B.4. TREATMENT DATES. A dentist who submits a claims form to a third party* reporting incorrect treatment dates for the purpose of assisting a patient in obtaining benefits under a dental plan, which benefits would otherwise be disallowed, is engaged in making an unethical, false or misleading representation to such third party*. 5.B.5. DENTAL PROCEDURES. A dentist who incorrectly describes on a third party* claim form a dental procedure in order to receive a greater payment or reimbursement or incorrectly makes a noncovered procedure appear to be a covered procedure on such a claim form is engaged in making an unethical, false or misleading representation to such third party*. 5.B.6. UNNECESSARY SERVICES. A dentist who recommends and performs unnecessary dental services or procedures is engaged in unethical conduct. The dentist’s ethical obligation in this matter applies regardless of the type of practice arrangement or contractual obligations in which he or she provides patient care. *A third party is any party to a dental prepayment contract that may collect premiums, assume financial risks, pay claims and/or provide administrative services.

2014 WDA Sourcebook

5.C. DISCLOSURE OF CONFLICT OF INTEREST. A dentist who presents educational or scientific information in an article, seminar or other program shall disclose to the readers or participants any monetary or other special interest the dentist may have with a company whose products are promoted or endorsed in the presentation. Disclosure shall be made in any promotional material and in the presentation itself. 5.D. DEVICES AND THERAPEUTIC METHODS. Except for formal investigative studies, dentists shall be obliged to prescribe, dispense or promote only those devices, drugs and other agents whose complete formulae are available to the dental profession. Dentists shall have the further obligation of not holding out as exclusive any device, agent, method or technique if that representation would be false or misleading in any material respect. ADVISORY OPINIONS 5.D.1. REPORTING ADVERSE REACTIONS. A dentist who suspects the occurrence of an adverse reaction to a drug or dental device has an obligation to communicate that information to the broader medical and dental community, including, in the case of a serious adverse event, the Food and Drug Administration (FDA). 5.D.2. MARKETING OR SALE OF PRODUCTS. Dentists who, in the regular conduct of their practices, engage in the marketing or sale of products to their patients must take care not to exploit the trust inherent in the dentist-patient relationship for their own financial gain. Dentists should not induce their patients to buy a product by misrepresenting the product’s therapeutic value or the dentist’s professional expertise in recommending the product or procedure. In the case of a health-related product, it is not enough for the dentist to rely on the manufacturer’s or distributor’s representations about the product’s safety and efficacy. The dentist has an independent obligation to inquire into the truth and accuracy of such claims and verify that they are founded on accepted scientific knowledge or research. Dentists should disclose to their patients all relevant information the patient needs to make an informed purchase decision, including whether the product is available elsewhere and whether there are any financial incentives for the dentist to recommend the product that would not be evident to the patient. 5.E. PROFESSIONAL ANNOUNCEMENT. In order to properly serve the public, dentists should represent themselves in a manner that contributes to the esteem of the profession. Dentists should not misrepresent their training and competence in any way that would be false or misleading in any material respect*. 5.F. ADVERTISING. Although any dentist may advertise, no dentist shall advertise or solicit patients in any form of communication in any manner that is false or misleading in any material respect*. ADVISORY OPINIONS 5.F.1. PUBLISHED COMMUNICATIONS. If a dental health article, message or newsletter is published in print or electronic media under a dentist’s byline to the public without making truthful disclosure of the source and authorship or is designed to give rise to questionable expectations for the purpose of inducing the public to utilize the services of the sponsoring dentist, the dentist is engaged in making a false or misleading representation to the public in a material respect. 5.F.2. EXAMPLES OF “FALSE OR MISLEADING.” The following examples are set forth to provide insight into the meaning of the term “false or misleading in a material respect.” These examples are not meant to be all-inclusive. Rather, by restating the concept in alternative language and giving general examples, it is hoped that the membership will gain a better understanding of the term. With this in mind, statements shall be avoided which would: a) contain a material misrepresentation of fact, b) omit a fact necessary to make the statement considered as a whole not materially misleading, c) be intended or be likely to create an unjustified expectation about results the dentist can achieve, and d) contain a material, objective representation, whether express or implied, that the advertised

Code of Ethics services are superior in quality to those of other dentists, if that representation is not subject to reasonable substantiation. Subjective statements about the quality of dental services can also raise ethical concerns. In particular, statements of opinion may be misleading if they are not honestly held, if they misrepresent the qualifications of the holder, or the basis of the opinion, or if the patient reasonably interprets them as implied statements of fact. Such statements will be evaluated on a case by case basis, considering how patients are likely to respond to the impression made by the advertisement as a whole. The fundamental issue is whether the advertisement, taken as a whole, is false or misleading in a material respect. WDA Interpretations a. It is unethical for dentists and dental organizations to give false or misleading testimonials, directly, or indirectly, concerning the supposed virtue of materials which are presented to the public, claiming cure or prevention of disease by their use.

5.F.3. UNEARNED, NONHEALTH DEGREES. A dentist may use the title Doctor or Dentist, DDS, DMD, or any additional earned, advanced academic degrees in health service areas in an announcement to the public. The announcement of an unearned academic degree may be misleading because of the likelihood that it will indicate to the public the attainment of specialty or diplomate status. For purposes of this advisory opinion, an unearned academic degree is one which is awarded by an educational institution not accredited by a generally recognized accrediting body or is an honorary degree. The use of a nonhealth degree in an announcement to the public may be a representation which is misleading because the public is likely to assume that any degree announced is related to the qualifications of the dentist as a practitioner. Some organizations grant dentists fellowship status as a token of membership in the organization or some other form of voluntary association. The use of such fellowships in advertising to the general public may be misleading because of the likelihood that it will indicate to the public attainment of education or skill in the field of dentistry. Generally, unearned or nonhealth degrees and fellowships that designate association, rather than attainment, should be limited to scientific papers and curriculum vitae. In all instances, state law should be consulted. In any review by the council of the use of designations in advertising to the public, the council will apply the standard of whether the use of such is false or misleading in a material respect. 5.F.4. REFERRAL SERVICES. There are two basic types of referral services for dental care: not-for-profit and the commercial. The not-for-profit is commonly organized by dental societies or community services. It is open to all qualified practitioners in the area served. A fee is sometimes charged to the practitioner to be listed with the service. A fee for such referral services is for the purpose of covering the expenses of the service and has no relation to the number of patients referred. In contrast, some commercial referral services restrict access to the referral service to a limited number of dentists in a particular geographic area. Prospective patients calling the service may be referred to a single subscribing dentist in the geographic area and the respective dentist billed for each patient referred. Commercial referral services often advertise to the public stressing that there is no charge for use of the service and the patient may not be informed of the referral fee paid by the dentist. There is a connotation to such advertisements that the referral that is being made is in the nature of a public service. A dentist is allowed to pay for any advertising permitted by the Code, but is generally not permitted to make payments to another person or entity for the referral of a patient for professional services. While the particular facts and circumstances relating to an individual commercial referral service will vary, the council believes that

5.F.5. INFECTIOUS DISEASE TEST RESULTS. An advertisement or other communication intended to solicit patients which omits a material fact or facts necessary to put the information conveyed in the advertisement in a proper context can be misleading in a material respect. A dental practice should not seek to attract patients on the basis of partial truths which create a false impression. For example, an advertisement to the public of HIV negative test results, without conveying additional information that will clarify the scientific significance of this fact, contains a misleading omission. A dentist could satisfy his or her obligation under this advisory opinion to convey additional information by clearly stating in the advertisement or other communication: “This negative HIV test cannot guarantee that I am currently free of HIV.” 5.G. NAME OF PRACTICE. Since the name under which a dentist conducts his or her practice may be a factor in the selection process of the patient, the use of a trade name or an assumed name that is false or misleading in any material respect is unethical. Use of the name of a dentist no longer actively associated with the practice may be continued for a period not to exceed one year*. ADVISORY OPINION 5.G.1. DENTIST LEAVING PRACTICE. Dentists leaving a practice who authorize continued use of their names should receive competent advice on the legal implication of this action. With permission of a departing dentist, his or her name may be used for more than one year, if, after the one year grace period has expired, prominent notice is provided to the public through such mediums as a sign at the office and a short statement on stationery and business cards that the departing dentist has retired from the practice.

Code of Ethics

b. It is unethical to promise false or misleading cures or boast of, prescribe or employ false or misleading methods of treatment, or remedies.

the aspects outlined above for commercial referral services violate the Code in that it constitutes advertising which is false or misleading in a material respect and violates the prohibitions in the Code against fee splitting.

5.H. ANNOUNCEMENT OF SPECIALIZATION AND LIMITATION OF PRACTICE. This section and Section 5-I are designed to help the public make an informed selection between the practitioner who has completed an accredited program beyond the dental degree and a practitioner who has not completed such a program. The special areas of dental practice approved by the American Dental Association and the designation for ethical specialty announcement and limitation of practice are: dental public health, endodontics, oral and maxillofacial pathology, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, and prosthodontics. Dentists who choose to announce specialization should use “specialist in” or “practice limited to” and shall limit their practice exclusively to the announced special area(s) of dental practice, provided at the time of the announcement such dentists have met in each approved specialty for which they announce the existing educational requirements and standards set forth by the American Dental Association. Dentists who use their eligibility to announce as specialists to make the public believe that specialty services rendered in the dental office are being rendered by qualified specialists when such is not the case are engaged in unethical conduct. The burden of responsibility is on specialists to avoid an inference that general practitioners who are associated with specialists are qualified to announce themselves as specialists. GENERAL STANDARDS. The following are included within the standards of the American Dental Association for determining the education, experience and other appropriate requirements for announcing specialization and limitation of practice: 1. The special area(s) of dental practice and an appropriate certifying board must be approved by the American Dental Association. 2. Dentists who announce as specialists must have successfully completed an educational program accredited by the Commission on Dental Accreditation, two or more years in length, as specified by the Council on Dental Education, or be diplomates of an American Dental Association recognized certifying board. The scope of the individual specialist’s practice shall be governed by the educational standards for the specialty in which the specialist is announcing. 2014 WDA Sourcebook

Code of Ethics 3. The practice carried on by dentists who announce as specialists shall be limited exclusively to the special area(s) of dental practices announced by the dentist.

Code of Ethics

STANDARDS FOR MULTIPLE-SPECIALTY ANNOUNCEMENTS. The educational criterion for announcement of limitation of practice in additional specialty areas is the successful completion of an advanced educational program accredited by the Commission on Dental Accreditation (or its equivalent if completed prior to 1967)* in each area for which the dentist wishes to announce. Dentists who are presently ethically announcing limitation of practice in a specialty area and who wish to announce in an additional specialty area must submit to the appropriate constituent society documentation of successful completion of the requisite education in specialty programs listed by the Council on Dental Education and Licensure or certification as a diplomate in each area for which they wish to announce. *Completion of three years of advance training in oral & maxillofacial surgery or two years of advanced training in one of the other recognized dental specialties prior to 1967. ADVISORY OPINIONS. 5.H.1. DUAL DEGREED DENTISTS. Nothing in Section 5.H shall be interpreted to prohibit a dual degreed dentist who practices medicine or osteopathy under a valid state license from announcing to the public as a dental specialist provided the dentist meets the educational, experience and other standards set forth in the Code for specialty announcement and further providing that the announcement is truthful and not materially misleading. 5.H.2. SPECIALIST ANNOUNCEMENT OF CREDENTIALS IN NON-SPECIALTY INTEREST AREAS. A dentist who is qualified to announce specialization under this section may not announce to the public that he or she is certified or a diplomate or otherwise similarly credentialed in an area of dentistry not recognized as a specialty area by the American Dental Association unless: 1. The organization granting the credential grants certification or diplomate status based on the following: a) the dentist’s successful completion of a formal, full-time advanced education program (graduate or postgraduate level) of at least 12 months’ duration; and b) the dentist’s training and experience; and c) successful completion of an oral and written examination based on psychometric principles; and 2. The announcement includes the following language: [Name of announced area of dental practice] is not recognized as a specialty area by the American Dental Association. Nothing in this advisory opinion affects the right of a properly qualified dentist to announce specialization in an ADA-recognized specialty area(s) as provided for under Section 5.H. of this Code or the responsibility of such dentist to limit his or her practice exclusively to the special area(s) of dental practice announced. Specialists shall not announce their credentials in a manner that implies specialization in a non-specialty interest area. 5.I. GENERAL PRACTITIONER. ANNOUNCEMENT OF SERVICES. General dentists who wish to announce the services available in their practices are permitted to announce the availability of those services so long as they avoid any communications that express or imply specialization. General dentists shall also state that the services are being provided by general dentists. No dentist shall announce available services in any way that would be false or misleading in any material respect.* ADVISORY OPINIONS. 5.I.1. GENERAL PRACTITIONER ANNOUNCEMENT OF CREDENTIALS INTEREST AREAS IN GENERAL DENTISTRY. A general dentist may not announce to the public that he or she is certified or a diplomate or otherwise similarly credentialed in an area of dentistry not recognized as a specialty area by the American Dental Association unless: 1. The organization granting the credential grants certification or diplomate status based on the following: a) the dentist’s successful completion of a formal, full-time

2014 WDA Sourcebook

advanced education program (graduate or postgraduate level) of at least 12 months’ duration; and b) the dentist’s training and experience; and c) successful completion of an oral and written examination based on psychometric principles; 2. The dentist discloses that he or she is a general dentist; and 3. The announcement includes the following language: [Name of announced area of dental practice] is not recognized as a specialty area by the American Dental Association. 5.I.2. CREDENTIALS IN GENERAL DENTISTRY. General dentists may announce fellowships or other credentials earned in the area of general dentistry so long as they avoid any communications that express or imply specialization and the announcement includes the disclaimer that the dentist is a general dentist. The use of abbreviations to designate credentials shall be avoided when such use would lead the reasonable person to believe that the designation represents an academic degree, when such is not the case. *Advertising, solicitation of patients or business or other promotional activities by dentists or dental care delivery organizations shall not be considered unethical or improper, except for those promotional activities which are false or misleading in any material respect. Notwithstanding any ADA Principles of Ethics and Code of Professional Conduct or other standards of dentist conduct which may be differently worded, this shall be the sole standard for determining the ethical propriety of such promotional activities. Any provision of an ADA constituent or component society’s code of ethics or other standard of dentist conduct relating to dentists’ or dental care delivery organizations’ advertising, solicitation or other promotional activities which is worded differently from the above standard shall be deemed to be in conflict with the ADA Principles of Ethics and Code of Professional Conduct. WDA Interpretation a. No dentist who has failed to meet the existing educational requirements and standards set forth by the American Dental Association for announcement of a specialization and limitation of practice may list his or her name under the heading of any specialty in the Yellow pages or any other announcements or advertisements.

IV. INTERPRETATION AND APPLICATION OF PRINCIPLES OF ETHICS AND CODE OF PROFESSIONAL CONDUCT. The foregoing ADA Principles of Ethics and Code of Professional Conduct has set forth the ethical duties that are binding on members of the American Dental Association. The component and constituent societies may adopt additional requirements or interpretations not in conflict with the ADA Code. Anyone who believes that a member-dentist has acted unethically may bring the matter to the attention of the appropriate constituent (state) or component (local) dental society. Whenever possible, problems involving questions of ethics should be resolved at the state or local level. If a satisfactory resolution cannot be reached, the dental society may decide, after proper investigation, that the matter warrants issuing formal charges and conducting a disciplinary hearing pursuant to the procedures set forth in the ADA Bylaws, Chapter XII. PRINCIPLES OF ETHICS AND CODE OF PROFESSIONAL CONDUCT AND JUDICIAL PROCEDURE. The Council On Ethics, Bylaws And Judicial Affairs reminds constituent and component societies that before a dentist can be found to have breached any ethical obligation the dentist is entitled to a fair hearing. A member who is found guilty of unethical conduct proscribed by the ADA Code or code of ethics of the constituent or component society, may be placed under a sentence of censure or suspension or may be expelled from membership in the Association. A member under a sentence of censure, suspension or expulsion has the right to appeal the decision to his or her constituent society and the ADA Council on Ethics, Bylaws and Judicial Affairs, as provided in Chapter XII of the ADA Bylaws.

Antitrust Statement

Wisconsin Dental Association Antitrust Statement (WDA House of Delegates 2008) • There will be no discussions about whether the practices of any member, actual or potential competitor, or other person are unethical or anti-competitive, unless the discussions or complaints follow the prescribed due process provisions of the Association’s bylaws.

• The Association or any committee, section, chapter, or activity of the Association shall not be used for the purpose of bringing about or attempting to bring about any understanding or agreement, written or oral, formal or informal, expressed or implied, among two or more members or other competitors with regard to prices or terms and conditions of contracts for services or products. Therefore, discussions and exchanges of information about such topics will not be permitted at Association meetings or other activities.

• Certain activities of the Association and its members are deemed protected from antitrust laws under the First Amendment right to petition government. The antitrust exemption for these activities, referred to as the Noerr-Pennington Doctrine, protects ethical and proper actions or discussions by members designed to influence: 1) legislation at the national, state, or local level; 2) regulatory or policy-making activities (as opposed to commercial activities) or a governmental body; or 3) decisions of judicial bodies. However, the exemption does not protect actions constituting a “sham” to cover anticompetitive conduct.

• There will be no discussions discouraging or withholding patronage or services from, or encouraging exclusive dealing with any supplier or purchaser or group of suppliers or purchasers of products or services, any actual or potential competitor or group of actual potential competitors or any private or governmental entity.

• Speakers at committees, educational meetings, or other business meetings of the Association shall be informed that they must comply with the Association’s antitrust policy in the preparation and the presentation of their remarks. Meetings will follow a written agenda approved in advance by the Association or its legal counsel.

• Any discussions of prices or price levels are prohibited. In addition, 1) no discussion is permitted of cost of operations, supplies, labor or services; 2) allowance for discounts; 3) terms of sale including credit arrangements, and; 4) profit margins and mark ups, provided this limitation shall not extend to discussions of methods of operations, maintenance, and similar matters in which cost or efficiency is merely incidental.

• Meetings will follow a written agenda. Minutes will be prepared after the meeting to provide a concise summary of important matters discussed and actions taken or conclusions reached.

• There will be no discussions about allocating or dividing geographic or service markets or customers. • There will be no discussions about restricting, limiting, prohibiting, or sanctioning advertising or solicitation that is not false, misleading, deceptive, or directly competitive with Association products or services. • There will be no discussions about discouraging entry into or competition in any segment of the marketplace.

Antitrust Statement

It shall be the policy of the WDA to be in strict compliance with all Federal and State Antitrust laws, rules and regulations. In order to ensure that the Wisconsin Dental Association and its members comply with anti-trust laws, the following principles will be observed:

At informal discussions at the site of any Association meeting, all participants are expected to observe the same standards of personal conduct as are required of the Association in its compliance. It is the policy of this Association that a copy of this Antitrust Compliance Policy be given to each officer, director, committee member, official representative of member companies, and Association employees annually and that the same be read, or understood at all meetings of the membership of the Association. For more antitrust information and examples, visit WDA.org (login required).

2014 WDA Sourcebook

WDA Political Action Team EMPOWER

WDA

WISCONSIN DENTAL ASSOCIATION

Overview

PAC programs

The Wisconsin Dental Association Political Action Team is made up of dentists and others affiliated with the dental community (e.g., students, spouses).

There are three financial components to the Political Action Team. You can contribute to any one component or divide your contribution among all three. If you want to participate in more than one component, you must write separate personal checks to each program.

WDA Political Action Team

By contributing to the Wisconsin Dental Political Action Committee, Direct Giver program and/or the American Dental Political Action Committee, team members work together to build and strengthen legislative relationships through bipartisan financial support of legislators and candidates who discuss, understand and support dental-related issues. WDA Political Action Team members promote dental care standards in this state by providing one-on-one education to elected officials on issues impacting the delivery of quality oral health care in Wisconsin.

What it does • Strengthens dentistry’s influence in the statewide political arena by pooling individual dentists’ financial contributions and distributing them with a single, powerful, pro-oral health voice to help select candidates, regardless of party affiliation, who support upholding dental care quality and standards. • Gives a name and face to the dental profession through grassroots members’ support for and communications with state legislators and state-level candidates. • Protects the integrity of the dental profession by educating legislators on how proposed legislation will affect dental patients, the quality of dental care in Wisconsin and dentistry’s unique small-business delivery model. • Identifies and supports legislators who have been friends of dentistry. • Helps give the dental profession a respected voice in the halls of the state Capitol. • Makes it easy for individual dentists to participate in politics through a mechanism that allows them to direct personal contributions to state candidates of their choice, while also emphasizing the dentist’s membership in the WDA.

2014 WDA Sourcebook

DG gives the dentist control Money is deposited into a DG account assigned to a dentist and is only released upon authorization by the dentist. These funds roll over from year to year (in a noninterest-bearing account) and can only be used for state races. If contacted by a state legislator and/or candidate for office, the WDA will also contact dentists who have DG balances to inform them about a fundraising event for a candidate in his or her area of the state. WIDPAC board exercises control Money is deposited into one large WIDPAC account and the WIDPAC board disperses it to candidates for state office based on voting records and leadership positions. WIDPAC funds also are available for a contributing dentist to attend local fundraisers. National ADPAC exercises control Money is sent to the ADPAC program in Washington, D.C. It is released to federal legislators based on voting records and leadership positions. ADPAC funds are available for dentists to attend a nd/or host local fundraisers for candidates at the national level.

WDA Political Action Team

WDA

WISCONSIN DENTAL ASSOCIATION

All contributions gratefully accepted. Minimal contribution amounts for special recognition are: $305 Grassroots $505 Leadership Circle $1,005 President’s Club $1,305 Bronze Club (target level) $1,505 Silver Club $2,005 Gold Club $75 spouse $15 student $105 first-year graduate $205 second-year graduate

Join the WDA Political Action Team today! Complete the information below and return with your contribution in one of three ways: • By phone - Contact the WDA Legislative Office at 888-538-8932 to sign-up using your personal credit card. • By fax - Photocopy this page this page, complete the information below and fax with your personal credit card information to 888-822-2932. • By mail - Photocopy this page, complete the information on below and send with personal check(s) or credit card info to: WDA, 122 W. Washington Ave., Ste. 600, Madison, WI 53703. (New address effective May 1, 2014)

Membership 2014

2014 WDA Sourcebook

WDA Political Action Team

• • • • • • • • • •

Become a member

EMPOWER

Contacting Your Legislators

How to contact your legislators The Wisconsin Dental Association gives the dental profession a unified voice in the legislative and regulatory arenas. One dentist alone may not be able to directly affect policies enacted at the state and federal levels, but 3,000 member dentists and 100+ member dental hygienists working together under the WDA umbrella can bring more attention to the issues affecting dentistry. Dentists should set aside a few hours each year to become better acquainted with their elected officials. To easily send an introductory email or note to your legislators, type in your home or office address at the following state legislative website: http://waml.legis.state.wi.us.

• Separate politics from discussions on policy matters – Never discuss political fundraisers or contributions while on state property or visiting the legislator in a Capitol office. Similarly, if you are attending a fundraising event in the district, feel free to discuss general issues of concern, but never discuss that legislator’s vote on a specific bill or issue while delivering a financial contribution and/or attending the event. • Ask for a clear response – Regardless of the issue, ask the legislator to take a position and inform you of that position in writing. Legislators may not commit unless they are specifically asked to do so. • Reward good work – Follow up with a short note or phone call to thank those legislators who have supported dentistry by their votes and actions.

Legislators know how to make policy, but they don’t always know how those policies affect you as a dentist or small-business owner.

• Communicate with staff – Don’t hesitate to talk to staffers if the legislator is busy, but make sure the legislator still follows up with a written response on the issue.

If you wish to preserve the profession for future dentists, please take the time to share your knowledge as a dentist and as a small-business owner with your elected officials.

• Maintain a relationship – The best way to get a legislator’s attention is to develop a friendship. Update them on your ideas and contact them with good news or just to check in and say “hi” from time-to-time.

Use your own judgment as to which method is more appropriate for communicating with your local legislators:

Other ways to get involved

• Visit your legislator either within their district or at their Capitol office. During session, legislators are usually in Madison on Tuesdays through Thursdays and in the district on the weekends. A personal visit is ideal, because it allows you to develop name and face recognition with the legislator.

You can also be part of the WDA Political Action Team by:

• Writing a letter or sending an email is often the preferred means of communication for legislators, because there is less chance for misinterpretation when staff is asked to research the issue and report back. Hand-written correspondence will always be read, so if you can pen a personal note on your office letterhead, that is a great approach. Keep written correspondence to a page or less. • Calling your legislator is also an option, but there is greater chance for miscommunication.

Ask for a written response on the issue • Do your homework – Read up on the issues affecting dentistry in the monthly editions of the WDA Journal. Issue papers are also posted in the member’s only section of WDA.org. Know the difference between state and federal issues. • Use personal experience – Tell legislators how your office works. Tell them about yourself as an employer, the size of your staff and how state laws and government programs affect your dental practice and the care you provide to your patients. • Be timely – Don’t wait until the issue has been acted on. Contact your legislators before opposing interest groups have taken the opportunity to do so. • Remain professional – When you speak, you not only represent yourself but the entire dental profession; be sincere about the concern you have for your patients when you are talking to legislators.

Attending fundraisers for legislative candidates during an election cycle is one way to help to bring awareness to dental issues, but there are also other ways you can affect the future of your dental profession.

Contacting your Legislators

Educate legislators about your dental practice

• Inviting elected officials and/or candidates to component meetings where they can meet dentists in their district and learn about dental health issues and dentistry’s small-business model. Promote an exchange of ideas and help develop relationships between dentists and the legislators representing them in Madison. • Building relationships at the local level by routinely communicating on dental issues with policymakers elected to office. • Attending local forums to meet candidates and discuss dental issues; offer to serve as a grassroots contact for your legislator whenever he/she reviews oral health legislation. • Volunteering to help a local candidate’s campaign through non-financial means, such as posting signs, participating in a “lit-drop” or writing letters to the editor. • Inviting dental colleagues to join the WDA Political Action Team and contribute funds, so dentistry can support candidates who vote in support of the “Tooth Party”.

Share information with WDA staff Contact the WDA Legislative Office call 888-538-8932 or mbrooks@wda.org for more information or questions.

2014 WDA Sourcebook

Wisconsin Legislators To identify your state legislators, go to http://waml.legis.state.wi.us/ and type in your home or office address.

Wisconsin Legislators

Wisconsin Members of Congress

Telephone Senator (Party) Dist. Office (608) Carpenter, Tim (D-Milwaukee) 3 109-S 266-8535 UNITED STATES SENATORS Cowles, Robert (R-Green Bay) 2 118-S 266-0484 Senate Office Building Cullen, Tim (D-Janesville) 15 108-S 266-2253 Washington, D.C. 20510 Darling, Alberta (R-River Hills) 8 317-E 266-5830 Ellis, Michael (R-Neenah) 19 220-S 266-0718 Tammy Baldwin (D) Ronald Johnson (R) Erpenbach, Jon (D-Middleton) 27 104-S 266-6670 Office: 17 Hart Office: 328 Hart Farrow, 33 323-S 266-9174 Paul (R-Pewaukee) Telephone: 202-224-5653 Telephone: 202-224-5323 Fitzgerald, Scott (R-Juneau) 13 211-S 266-5660 Grothman, Glenn (R- West Bend) 20 10-S 266-7513 Gudex, Richard (R-Fond du Lac) 18 415-S 266-5300 United States House of Representatives Hansen, Dave (D-Green Bay) 30 106-S 266-5670 House Office Building Harris, Nikiya (D-Milwaukee) 6 3-S 266-2500 Washington, D.C. 20515 Harsdorf, Shelia (R-River Falls) 10 18-S 266-7745 Jauch, Robert (D-Poplar) 25 310-S 266-3510 Office Telephone (202) Dist. Name (Party) Kedzie, Neal (R-Elkhorn) 11 313-S 266-2635 Paul Ryan (R) 1233 Longworth 225-3031 1 7 206-S 266-7505 Larson, Chris (D-Milwaukee) 2 Mark Pocan (D) 313 Cannon 225-2906 Lasee, Frank (R-De Pere) 1 316-S 266-3512 Ron Kind (D) 1502 Longworth 225-5506 3 Lassa, Julie (D-Stevens Point) 24 126-S 266-3123 4 Gwen Moore (D) 2245 Rayburn 225-4572 Lazich, Mary (R-New Berlin) 28 8-S 266-5400 5 F. James Sensenbrenner (R) 2449 Rayburn 225-5101 Lehman, John (D-Racine) 21 5-S 266-1832 6 Thomas Petri (R) 2462 Rayburn 225-2476 9 15-S 266-2056 Leibham, Joseph (R-Sheboygan) 7 Sean P. Duffy (R) 1208 Longworth 225-3365 Miller, Mark (D-Monona) 16 7-S 266-9170 Reid Ribble (R) 1513 Longworth 225-5665 8 Moulton, Terry (R-Chippewa Falls) 23 306-S 266-7511 Olsen, Luther (R-Ripon) 14 319-S 266-0751 Petrowski, Jerry (R-Marathon) 29 123-S 266-2502 Wisconsin Constitutional Officers 26 130-S 266-1627 Risser, Fred (D-Madison) State Capitol • Madison, WI 53707 Schultz, Dale (R-Richland Center) 17 122-S 266-0703 Telephone Shilling, Jennifer (D-La Crosse) 32 20-S 266-5490 Name (Party) P.O. Box (608) Taylor, 4 19-S 266-5810 Lena (D-Milwaukee) Gov. Scott Walker (R) 7863 266-1212 Tiffany, 12 409-S 266-2509 Thomas (RHazelhurst) Room 115 East Capitol 31 22-S 266-8546 Vinehout, Kathleen (D-Alma) 2043 266-3516 Lt. Gov. Rebecca Kleefisch (R) Vukmir, 5 131-S 266-2512 Leah (R-Wauwatosa) Secretary of State Doug J. La Follette (D) 7848 266-8888 Wirch, Robert (D-Pleasant Prairie) 22 127-S 267-8979 Treasurer Kurt W. Schuller (R) 7871 266-1714 Attorney General J.B. Van Hollen (R) 7857 266-1221 Mailing address: PO Box 7882, Madison, WI 53707 Superintendent Public Instruction Tony Evers 7841 266-1771 Email: Sen.[last name]@legis.wisconsin.gov Key to all legislative offices: E, W, N, S = Wing in the Capitol building and RJC (Risser Justice Center) = 17 W. Main St. Wisconsin State Assembly State Capitol • Madison, WI 53702 Telephone Wisconsin State Senate Leadership (Party) Office (608) State Capitol • Madison, WI 53707 Speaker Robin Vos (R-Rochester) 211-W 266-9171 Telephone Speaker Pro Tempore Tyler August (R-Lake Geneva) 119-W 266-1190 Office (608) Leadership (Party) Majority Leader - Vacant 115-W 266-8580 President Michael Ellis (R-Neenah) 220-S 266-0718 204-N 266-2418 Assistant Leader Jim Steineke (R-Kaukauna) President Pro Tempore Joseph Leibham (R-Sheboygan) 15-S 266-2056 Minority Leader Peter Barca (D-Kenosha) 201-W 266-5504 Majority Leader Scott Fitzgerald (R-Juneau) 211-S 266-5660 119-N 266-7671 Assistant Leader Sandy Pasch (D-Shorewood) Assistant Leader Glenn Grothman (R- West Bend) 10-S 266-7513 Chief Clerk Patrick Fuller 401-RJC 266-1501 Minority Leader Chris Larson (D-Milwaukee) 206-S 266-7505 Sergeant-At-Arms Anne Tonnon Byers 411-W 266-1503 Assistant Leader Dave Hansen (D-Green Bay) 106-S 266-5670 Chief Clerk Jeffrey Renk B20-SE 266-2517 Key to all legislative offices: E, W, N, S=Wings in Capitol Building, (RJC) Risser Justice Center=17 W. Main St. Sergeant-At-Arms Edward A. Blazel B35S-C 266-1801

2014 WDA Sourcebook

Wisconsin Legislators Telephone (608) 266-1190 266-8077 266-5504 266-3756 266-3784 266-3070 266-9172 266-7690 266-5350 266-5780 266-2540 266-8531 266-7746 266-3363 266-7694 266-7015 266-0631 266-0656 266-0616 266-0645 266-7678 266-5340 266-2254 266-7521 267-9836 266-9870 266-9650 266-5580 266-3790 266-8570 266-3007 266-5719 266-2530 266-5813 266-8530 266-8551 266-0485 266-3796 266-1526 266-7503 266-9180 266-8580 266-0215 267-5158 267-0280 266-1194 266-9175 266-9967 266-7502 266-0634 266-0640 266-7500 266-3780 266-7683 266-5715 266-3534 266-5120 266-2343 266-0455 266-5831 266-0486 266-7671

*Rep. (Party/Hometown) Dist. Office Petersen, Kevin (R-Waupaca) 40 105-W 93 103-W Petryk, Warren (R-Eleva) Pope, Sondy (D-Cross Plains) 80 111-N Pridemore, Don (R-Hartford) 22 318-N 19 118-N Richards, Jon (D-Milwaukee) Riemer, Daniel (D-Milwaukee) 7 409-N 45 321-W Ringhand, Janis (D-Evansville) Ripp, Keith (R-Lodi) 42 223-N Rodriguez, Jessie (R-Franklin) 21 21-N 15 306-N Sanfelippo, Joe (R-West Allis) Sargent, Melissa (D-Madison) 48 8-W 53 22-W Schraa, Michael (R-Oshkosh) Severson, Erik (R-Star Prairie) 28 221-N Shankland, Katrina (D-Stevens Point) 71 418-N 20 114-N Sinicki, Christine (D-Milwaukee) Skowronski, Keith (R-Franklin) 82 121-W 75 4-W Smith, Stephen (D-Shell Lake) Spiros, John (R-Marshfield) 86 17-N Steineke, Jim (R-Kaukauna) 5 204-N 58 324-E Strachota, Patricia (R-West Bend) Stroebel, Duey (R-Saukville) 60 207-N Swearingen, Rob (R-Rhinelander) 34 107-W Tauchen, Gary (R-Bonduel) 6 13-W Taylor, Chris (D-Madison) 76 306-W Thiesfeldt, Jeremy (R-Fond du Lac) 52 16-W Tittl, Paul (R-Manitowoc) 25 18-N Tranel, Travis (R-Cuba City) 49 308-N Vos, Robin (R-Rochester) 63 211-W Vruwink, Amy Sue (D-Milladore) 70 112-N Wachs, Dana (D-Eau Claire) 91 302-N Weatherston, Thomas (R-Racine) 62 109-W Weininger, Chad (R-Green Bay) 4 125-W Williams, Mary (R-Medford) 87 17-W Wright, Mandy (D-Wausau) 85 10-W Young, Leon (D-Milwaukee) 16 11-N Zamarripa, JoCasta (D-Milwaukee) 8 320-W Zepnick, Josh (D-Milwaukee) 9 7-N

Telephone (608) 266-3794 266-0660 266-3520 267-2367 266-0650 266-1733 266-1192 266-3404 266-0610 266-0620 266-0960 267-7990 267-2365 267-9649 266-8588 266-8590 266-2519 266-1182 266-2418 264-8486 267-0820 266-7141 266-3097 266-5342 266-3156 266-0315 266-1170 266-9171 266-8366 266-7461 266-0731 266-5840 266-7506 266-0654 266-3786 267-7669 266-1707

Wisconsin Legislators

*Rep. (Party/Hometown) Dist. Office August, Tyler (R-Lake Geneva) 32 119-W Ballweg, Joan (R-Markesan) 41 210-N 64 201-W Barca, Peter (D-Kenosha) Barnes, Mandela (D-Milwaukee) 11 9-W 77 104-N Berceau, Terese (D-Madison) Bernard Schaber, Penny (D-Appleton) 57 126-N Bernier, Kathleen (R-Chippewa Falls) 68 314-N 74 322-W Bewley, Janet (D-Ashland) Bies, Garey (R-Sister Bay) 1 216-N 95 307-W Billings, Jill (D-La Crosse) Born, Mark (R-Beaver Dam) 39 312-N Brooks, Edward (R-Reedsburg) 50 20-N 81 122-N Clark, Fred (R-Sauk City) Craig, David (R-Big Bend) 83 127-W 35 15-W Czaja, Mary (R-Irma) Danou, Chris (D-Trempealeau) 92 107-N Doyle, Steve (D-Onalaska) 94 124-N 26 219-N Endsley, Mike (R-Sheboygan) Genrich, Eric (D-Green Bay) 90 304-W Goyke, Evan (D-Milwaukee) 18 412-N Hebl, Gary (D-Sun Prairie) 46 120-N Hesselbein, Dianne (D-Middleton) 79 9-N Hintz, Gordon (D-Oshkosh) 54 109-N Hulsey, Brett (D-Madison) 78 5-N Hutton, Rob (R-Brookfield) 13 3-N Jacque, Andre (R-De Pere) 2 123-W Jagler, John (R-Watertown) 37 316-N Johnson, LaTonya (D-Milwaukee) 17 303-W Jorgensen, Andy (D-Fort Atkinson) 43 113-N Kahl, Robb (D-Monona) 47 7-W Kapenga, Chris (R-Delafield) 99 220-N Kaufert, Dean (R-Neenah) 55 15-N Kerkman, Samantha (R-Powers Lake) 6 1 315-N Kessler, Frederick (D-Milwaukee) 12 128-N Kestell, Steve (R-Elkhart Lake) 27 212-N Kleefisch, Joel (R-Oconomowoc) 38 307-N Klenke, John (R-Green Bay) 88 306-E Knodl, Daniel (R-Germantown) 24 218-N Knudson, Dean (R-Hudson) 30 320-E Kolste, Debra (D-Janesville) 44 8-N Kooyenga, Dale (R-Brookfield) 14 321-E Kramer, Bill (R-Waukesha) 97 115-W Krug, Scott (R-Nekoosa) 72 208-N Kuglitsch, Mike (R-New Berlin) 84 129-W Kulp, Bob (R-Stratford) 69 21-N Larson, Thomas (R-Colfax) 67 18-W LeMahieu, Daniel (R-Cascade) 59 304-E Loudenbeck, Amy (R-Clinton) 31 209-N Marklein, Howard (R-Spring Green) 51 214-N Mason, Cory (D-Racine) 66 6-N Milroy, Nick (D-South Range) 73 11-W Murphy, David (R-Greenville) 56 304-N Mursau, Jeffrey (R-Crivitz) 36 113-W 29 309-N Murtha, John (R-Baldwin) Nass, Stephen (R-Whitewater) 33 12-W Nerison, Lee (R-Westby) 96 310-N Neylon, Adam (R-Pewaukee) 98 19-N Nygren, John (R-Marinette) 89 309-E Ohnstad, Tod (D-Kenosha) 65 420-N Ott, Alvin (R-Forest Junction) 3 323-N Ott, Jim (R-Mequon) 23 317-N Pasch, Sandy (D-Shorewood) 10 119-N

Mailing addresses: • Last names beginning A-L mail to: PO Box 8952, Madison, WI 53708. • Last names beginning M-Z mail to: PO Box 8953, Madison, WI 53708.

CapWiz to contact your legislators on dental issues www.wda.org (Member log-in required) Identify and contact your legislators http://waml.legis.state.wi.us State legislative hotline • 800-362-9472 Madison area legislative hotline 608-266-9960 Wis. State Legislative website www.legis.state.wi.us U.S. Senate website www.senate.gov U.S. House website www.house.gov

2014 WDA Sourcebook

Government Agencies

Government agencies that impact dentistry STATE Department of Administration Office of Business Development Email: doaobd@wisconsin.gov Website: www.doa.wi.gov/Divisions/ Office-of-Business-Development Department of Health Services Phone: 608-266-1865 Website: www.dhs.wisconsin.gov

Government Agencies

Dental Medicaid Information Website: www.dhs.wisconsin.gov/Medicaid Division of Health Care Access and Accountability Dental Consultant (Dr. Robert Dwyer) Phone: 608-264-6754 Email: robert.dwyer@wisconsin.gov Division of Radiation Protection Website: www.dhs.wisconsin.gov/radiation William Balke, X-ray Supervisor Phone: 608-267-4787 Email: William.Balke@dhs.wi.gov

Department of Safety and Professional Services Phone: 608-266-2112 Fax: 608-267-0644 Website: www.dsps.wi.gov Email: DSPSboards@wisconsin.gov Legislative hotline • 800-362-9472

Dr. Jeffrey Chaffin, Chief Dental Officer Phone: 608-266-5152 Email: jeffrey.chaffin@wisconsin.gov

Department of Workforce Development Phone: 608-266-6860 Website: http://dwd.wisconsin.gov/default.htm

Robbyn Kuester, RDH Sealant and Fluoridation Program Coordinator Phone: 608-266-0876 Email: robbyn.kuester@wisconsin.gov

Worker’s Compensation Division Phone: 608-266-1340 Fax: 608-267-0394

Fluoride and other oral health fact sheets Website: www.dhs.wisconsin.gov/health/Oral_ Health/FactSheets.htm Department of Natural Resources – Bureau of Waste Management Phone: 608-266-2111 Website: http://dnr.wi.gov

Medicaid provider hotline Phone: 800-947-9627 Website: www.forwardhealth.wi.gov

Hazardous waste overview and mercury recycling Website: http://dnr.wi.gov/topic/Waste/ Hazardous.html

Medicaid recipient hotline Phone: 800-362-3002

Hazardous Waste Program Coordinator Patricia Chabot Patricia.Chabot@wisconsin.gov 608-264-6015

FEDERAL Centers for Disease Control and Prevention Phone: 800-232-4636 • Sterilization guidelines www.infection-control.com/CDC-Dental-Guidelines. html • Infection control practices for dentistry www.cdc.gov/OralHealth/infectioncontrol/ guidelines • CDC oral health www.cdc.gov/oralhealth U.S. Department of Health and Human Services Phone: 877-696-6775 Website: www.hhs.gov HIPAA General Information: Centers for Medicaid and Medicare Services (CMS) Website: www.cms.hhs.gov/HIPAAGenInfo Health Information Privacy: Office of Civil Rights (OCR) – patient privacy and discrimination issues Website: www.hhs.gov/ocr/privacy Health Resources and Services Administration (HRSA) loan assistance and community funding programs. Website: www.hrsa.gov 56

Managed Care Services (Kenosha, Milwaukee, Ozaukee, Racine and Waukesha counties) Phone: 608-266-7894 Division of Public Health Phone: 608-266-1251 Website: www.dhs.wisconsin.gov/aboutdhs/dph/ dph.htm

2014 WDA Sourcebook

Department of Labor Phone: 866-487-2365 Small business information Website: www.dol.gov/elaws Drug Enforcement Administration Website: www.justice.gov/dea/index.htm General questions: 202-307-1000 • Washington D.C. Phone: 202-305-8500 • Registration (call to get DEA number) Phone: 800-882-9539 • Chicago Phone: 312-353-7875 Food and Drug Administration Phone: 800-216-7331 or 301-575-0156 Website: www.fda.gov Dental amalgam information Website: www.fda.gov/MedicalDevices/ ProductsandMedicalProcedures/DentalProducts/ DentalAmalgam/default.htm National Institutes of Health Phone: 301-496-4000 Website: www.nih.gov

Employer poster requirements and employment laws Website: http://dwd.wisconsin.gov/dwd/posters.htm Office of the Commissioner of Insurance Phone: 608-266-3585 or 800-236-8517 Website: www.oci.wi.gov Complaints and Information Phone: 608-266-3585 or 800-236-8517 Email: ocicomplaints@wisconsin.gov

National Institute of Dental and Craniofacial Research Website: www.nidcr.nih.gov Occupational Safety and Health Administration Phone: 800-321-6742 Website: www.osha.gov WDA resource: Bloodborne Pathogens Guidelines for Dental Offices www.wda.org OSHA and Dentistry www.osha.gov/SLTC/dentistry • Appleton Phone: 920-734-4521 • Chicago Phone: 312-353-2220 • Eau Claire Phone: 715-832-9019 • Madison Phone: 608-441-5388 • Milwaukee Phone: 414-297-3315

WDA Legislative Priorities

Legislative Priorities for 2013-14 session (Updated Jan. 27, 2014)

HIGH PRIORITY The WDA will actively pursue meetings and necessary activities relating to the following designated “high priority items”. Definition of Dentistry (Scope of Practice) – This change would delete the current rather lengthy procedure-based definition with the more general language provided by the American Dental Association in the mid-1990s. The ADA model language avoids the listing of any specific dental procedures and allows for the practice of dentistry to include the provision of the latest research-based oral health treatment modalities and services to patients as long as it is within the individual dentist’s education, training and experience. Fiscal impact to the state: Minimal Department Safety and Professional Services administrative costs. Employee Trust Funds - State Employee Dental Benefit – The WDA has worked with the Dental Benefits Committee Chair and SIMPLE owner Roger Schultz to advance the concept of implementing a self-funded Direct Reimbursement plan for the state of Wisconsin employees beginning in 2015 and beyond.

MEDIUM PRIORITY The WDA advocates for or pursues meetings and activities on the following issues but prefers if possible to do so as part of a larger group or by reacting. This category also includes those pieces of legislation that require WDA review and reaction when proposed by other entities. Regulation of Mobile Dental Clinics - In the fall 2012, the Department of Health Services finalized and released a guidance to the superintendents and nurses of public and private schools. The Wisconsin Oral Health Coalition is also looking at advocating for legislation to ensure all dental providers that provide care in school settings are held to a similar standard of care and that the school districts have some assurances that there will be access to patient dental records and continuity of care.

Opposition to the Building of a Second Dental School – The WDA continues to oppose the building of a second dental school in Wisconsin because the Wisconsin dental workforce survey provided data that there will be a sufficient supply of dentists until 2020. The WDA’s support for accredited residency programs in this state will help facilitate the recruitment and placement of dentists in rural areas and help even out the distribution of dentists in the state.

WDA L egislative P riorities

Visit WDA.org (Legislative Advocacy members-only section) to view the complete WDA Legislative Priorities with status updates. Review the Government Buzz to learn more about dental-related policies and legislation which is also posted on WDA.org and printed in the WDA Journal.

Furthermore, the state’s investment of $8 million for an expansion of the accredited dental school at Marquette University School of Dentistry serves to address whatever potential need for additional dentists the state may have beyond 2020 (MUSOD dental enrollment increases from 320 students per year to 400 students - each class increases from 80 per class to 100 per class). There are concerns that given a serious nationwide shortage of dental faculty, a second dental school will fail to attract enough qualified dental instructors which are essential to providing an accredited dental education. It is clear that the state has struggled to maintain its minimal level of financial support for the current accredited dental school at Marquette and a second dental educational facility (which has not even obtained accreditation) has already begun to compete with Marquette for these limited state resources. Assignment of Benefits/Direct Pay Legislation - Assignment of Benefits/”Direct Pay” legislation would require dental benefit plans to honor a request from a covered individual who proactively asks for the payment to be made by their dental benefit plan to a non-network dentist who rendered the service, assuming the plan would reimburse the patient for part of the costs of that out-of-network care. This legislation would make the “assignment” valid only in those circumstances when the patient has made a written request to assign their benefits to the provider. Fiscal impact to the state: $0. Any Willing Provider Legislation - The WDA is supportive of an effort to allow patient freedom of choice and to allow that any provider who is willing to agree to the terms and 2013 WDA Sourcebook

WDA Legislative Priorities payments offered by a plan should be allowed to enroll in and receive reimbursement from that plan. This is consistent with the WDA “Patient Freedom within Dental Benefit Plans” policy which reads, “The Wisconsin Dental Association supports dental plans that allow patient freedom to seek care from a dentist of their choice, building an individual relationship of mutual trust in an open supply and demand marketplace”. Reactive Items (Miscellaneous) – Actively track items introduced by other entities that could impact (negatively or positively) the delivery of dental care to patients and/or the ability of dentists to run an efficient, cost-effective business. The board determines the final WDA position and/or action and its respective priority on an issue-by-issue basis. Fiscal impact to the state: Unknown until items are introduced and fiscal estimates are provided by appropriate state agencies.

WDA L egislative P riorities

AB 120/SB 129 - “I’m Sorry Bill” - Consistent with the WDA’s position in the past, WDA registered in support of legislation that would prohibit the use of an apology or statement of regret or fault from a provider to a patient as evidence in a civil or administrative trial. This bill received a public hearing in the Assembly Committee on Health on May 29 and the WDA submitted a registration slip in support of the bill. It passed out of Assembly Health Committee on June 20 and awaits action of the full Assembly. The Senate version has not yet received a hearing before the Judiciary Committee. AB 481 state Rep. Garey Bies “Tobacco Tax Parity Bill“ - This bill would close several loopholes in our state law that allow new candy-flavored tobacco products to dodge Wisconsin’s cigarette tax and sell at a price meant to target children. The sales of these products nationwide have increased 240 percent in the last decade due almost entirely to tax discrepancies. The WDA will register in support of this proposal. No hearings have been held. Federal Medicaid Funds - The WDA has chosen to not take a position/remain neutral on whether or not the state should accept Medicaid funds to cover non-pregnant adults up to 138 percent of the federal poverty level. The governor has made a decision to decline the use of those funds which will move those who are currently covered under Medicaid between 100-200 percent of FPL from Medicaid which has an adult dental benefit to the exchanges which will have no adult dental benefits. This issue was debated by the Joint Committee on Finance and many provider groups have come out in support of changing the governor’s plans and accepting the federal funds. The governor’s position of not accepting federal «expansion» funds remained intact and was signed into law June 30, 2013.

Fiscal impact to the state: It is unknown what it would cost the state to remove the HMO providers from the delivery of dental care in the southeastern region of the state; any cost increases would be because more people are being seen. (b) Multi-County Medicaid Reimbursement Pilot - In the recent past, the WDA has offered support for a multi-county pilot project to test fair-market reimbursement however given the tight budgets of recent years, there have been very few legislators who have taken the lead on this. (c) Dental Medicaid ER Pilot - In addition, the WDA would be supportive of a pilot program that would attempt to divert patients from emergency rooms while helping to ensure that state funds spent on dental care are focused on paying for definitive dental treatment rather than on expensive palliative treatments in the emergency rooms that fail to address the root cause of their dental problem which then often leads to repeat visits. Fiscal impact to the state: Any pilot program for ER visits and/or rate increases would depend largely on the benefits provided as well as the geographic and demographic limitations of the pilot. (d) Special Needs Hospitalization Medicaid Pilot - The WDA staff has been working with Drs. Stan Brysh and Joe Kotnour on gathering more information on how difficult it can be for a general dentist to see special needs patients in a hospital setting. The purpose of these meetings has been to gather information that can be shared with the state’s Medicaid director to see if they would be open to providing targeted higher rates for Medicaid dental services when those services are provided to the more severely disabled patients in a hospital setting (similar to what is available to pediatric patients who also need hospitalization). Expanded Delegation Legislation (Workforce/Access) – In WDA supports legislative language that will provide dentists with the freedom and authority to delegate more duties to certified “Expanded Function Dental Auxiliaries” within the dental practice. These duties include the following: placement and finishing of restoration material after the decay has been removed by the dentist; sealants; coronal polishing; impressions; temporizations; packing cord; removal of cement from crowns; denture and other removable oral appliance adjustments and suture/dressing removals. Under the proposed language, the dentist would remain responsible for all procedures delegated to an EFDA and the dentist would be required to remain on the premises and be available to the patient throughout the performance of the procedures which includes a requirement that the dentist check the patient and verify the successful completion of the procedure prior to the patient’s departure from the practice. The Dentistry Examining Board would be authorized to delineate the specific educational and training requirements for certification as an EFDA.

This issue is no longer being debated and it can be moved off the priority listing.

Fiscal impact to the state: Costs of establishing a certification review program (hopefully one-time - not annual) will be included along with the minimal costs of rule making at DSPS.

Dental Medicaid Program (Access) –

Marquette University School of Dentistry -

(a) Removal of HMOs from SE Dental Medicaid - The WDA has been, and remains, in favor of removing the HMOs from the delivery of dental Medicaid services in southeastern Wisconsin counties and based on the 2008 Wisconsin Legislative Audit report, the WDA has worked hard over the years (but without success) to advocate for a transition to fee-for-service dentistry in these six counties.

The WDA has offered to play a supportive role for two MUSOD state budget priority issues during the 2013-14 budget session. There was some success on the tuition subsidy issue.

The WDA government services division was successful, however, in convincing the state to hold the HMOs accountable for their contractual obligation with the state to pay all Medicaid HMO contracted dentists in the six Southeastern Wisconsin counties (Racine, Kenosha, Waukesha, Milwaukee, Washington and Ozaukee) at 100 percent of the fee-for-service dental Medicaid rates which led to a successful collection of funds owed to contracted dentists in 2012.

Based on our ongoing efforts to convince the state to implement a fee-for-service model in SE Wisconsin, it continues to appear that regardless of which party holds the governor’s office, DHS will continue to advocate for HMO delivery in dentistry in Southeastern Wisconsin.

2014 WDA Sourcebook

These activities were all tied to the biennial state budget and those that were addressed have passed and those that were not addressed will have to wait until the next budget cycle (January 2015) to be addressed. The issues include: (a) Support for restoring the current state contract with MUSOD for clinical services from the current rate of $2.3 million per year to its pre-2009 level of $2.8 million per year.

WDA Legislative Priorities With these funds, MUSOD has been able to serve approximately 27,000 patients per year who come from 66 of Wisconsin’s 72 counties. Fiscal cost over the biennium is $843,680.. (b) Restore the tuition subsidy for in-state Wisconsin residents from the current $8,665 to its pre-2003 level of $11,670 per Wisconsin resident enrolled at MUSOD. Fiscal cost over the biennial budget cycle $1,202,000 ($3,005 increase/student X 200 Wisconsin residents per year X two years of each biennium).

LOW PRIORITY The WDA offers support/assistance and/or monitors relevant activity and attends appropriate issue meetings, but does not take an active or lead role in pursuing legislation or changes to current practices. Support for AB 270 - Expanding Eligibility for State Volunteer Liability Program - This proposal adds some additional health care provider groups to those who can apply for state coverage if they volunteer their time at a state-approved clinic for underserved populations and receive no compensation.

The WDA worked constructively with the lead authors of the bill to add language that limits dental procedures to «simple extractions» and we were successful in allowing any dental procedures to be provided as long as the only anesthetic that was used was local anesthetic.

Support for 2013 AB 107 - Entertainer Surety Bond, Increase in Minimum Without Tax - This bill was introduced by state Rep. Garey Bies (R-Sister Bay) and it has no senate companion bill but it does have both Republican and Democratic co-sponsors in the Assembly. This bill would have a positive impact on our efforts to recruit speakers to our annual Continuing Education meetings each year because it would increase the minimum salary and out of state speaker could receive without having to pay Wisconsin state income taxes. Currently, any speaker earning more than $3,200 in a year would have to report and pay taxes on that income; this bill would increase the minimum to $7,000. This would have a positive impact because many states do not consider speaker income as taxable and so Wisconsin can be at a disadvantage in that our rates have to be higher in order to attract the same speaker here as in a state that doesn’t tax income. Many but not all of the WDA speakers are at or below the $7,000 mark. SB 391/AB 619 - Out of State Providers Providing Charity Care in Wisconsin - This bill proposes to allow any health care provider that would qualify under the state’s existing Volunteer Health Care Provider Program to come into our state and practice 60 of every 90 days (up to 8 months of a year) without ever having to be licensed in our state. Furthermore, as long as they also show proof to a nonprofit agency (who have filed their program with the state’s Dept of Administration) of their liability coverage, it allows them be immune from any civil charges against them as long as they are not willfully negligent or violating existing state laws. We also are a bit at a loss as to what the push for this measure might be and why there is a rush to pass it. WDA staff testified at the Assembly Health Committee for informational purposes and basically asked a lot of questions as to how this could impact licensure requirements and create two tiers of licensure in our state.

Senate Bill 311/Assembly Bill 408 - Support for Delegating the administration of Nitrous Oxide Inhalation to Certified Dental Hygienists - The WDA is supportive of a proposal by the Wisconsin Dental Hygienists’ Association which would seek to pass legislation allowing dentists to delegate to dental hygienists the administration of nitrous oxide inhalation to patients as long as the hygienist has been certified in nitrous oxide administration (by the DEB) and as long as the treatment is done in accordance with a treatment plan prescribed by the dentist and the dentist is on the premises and is available to the patient throughout the entire appointment.

We also provided the example of how our current practice act already provides for licensure of dentists and dental hygienists from other states to come in and provide charity care for up to 10 days in a calendar year without any cost to the temporary licensure.

The WDHA has been responsible for working the bill through the legislative process but it is something we will support and testify in support of as it moves through the process.

Loan Forgiveness and Grant Program (Workforce/Access) – Under the concept previously approved by the WDA House of Delegates, the WDA would support an effort by the legislature to create a state loan program that would reimburse up to $20,000 a year during five years of service provided the dentist saw 50 new Medicaid patients during each of those five years (250 M.A. seen during the fifth year of service).

The WDA informed the WDHA that we would also be supportive of the removal of the requirement that a patient be a patient of record of six months or more prior to receiving care by a dental hygienist without the dentist present. WDHA indicated they are also supportive of removal of the six-month requirement and included this provision in their legislation. Appointments to the Dentistry Examining Board –The WDA has been active in promoting to its members the opportunity to serve as a member of the state’s Dentistry Examining Board. It is WDA’s strong desire to make sure any dentists and dental hygienists who are appointed are members of the association and are actually willing to commit to attending all the meetings and be engaged in the proceedings. WDA leadership and staff share background information on responsibilities of a DEB member with any dentists or dental hygienists who have an interest in submitting and application to the governor’s office. WDA will also provide feedback to the Governor’s staff regarding the candidates they have narrowed down to be on their “short list“.

WDA L egislative P riorities

Dental assistants were originally included in the bill draft but later removed because the state doesn’t want to provide liability to those individuals who are not licensed by the state. This bill also includes some reporting for the free clinics who utilize the system and it also changes the application process by moving to an online electronic system that coordinates efforts between both Dept of Health Services and the Dept of Administration.

Fiscal impact to state: $0.

WDA is currently the only provider group raising questions or concerns on this issue. We hope to have some clarification provided before the Assembly moves forward on final passage of this bill.

The program would also make available $30,000 in annual grants to dental students over the four years of dental school; upon graduation, the new dentist would be required to practice at least four years in a DHPSA and see 50 new MA patients every year for those four years (200 MA patients seen during the fourth year of service). Fiscal impact to the state: Once fully implemented (four or five years into the program) the cost of a more robust loan forgiveness and grant program would be $1 million in GPR each year. Support Urban and Rural Accredited Dental Residency Programs – The WDA agrees with the 2010 DHS Feasibility Study on Dental Education which essentially stated that more dental residencies in urban and rural underserved areas could potentially have a positive impact on dental access by increasing the exposure of recent graduates to practices in both urban and rural underserved areas of the state. The WDA remains supportive regardless of whether these programs are offered by Marquette or other Wisconsin institutions that have obtained CODA accreditation for their programs.

2014 WDA Sourcebook

WDA Legislative Priorities It has been brought to our attention that the Marshfield effort to create a dental residency program within its facility has cleared the initial step of obtaining CODA accreditation and the Marshfield website currently includes an application process for prospective residents to complete. Health Care Exchanges – Inclusion of Dental Messaging – The WDA has monitored how the national health care reform legislation interprets the mandatory requirement that all state health care exchanges include “pediatric dental benefits” in their “essential services” package. The WDA’s activity on dental coverage within the exchanges has been driven by the following underlying philosophy: the state’s transition to Health Care Exchanges should not reduce the number of Wisconsinites who currently have dental benefit coverage through their employers. The WDA is also concerned that with stand-alone dental plans (dental coverage that is not embedded in a medical plan) being offered on the exchanges as an optional benefit for adults, many adults will choose not to purchase dental benefits and we’d like to first encourage their purchase of benefits but realizing that many will not want to take on an additional premium, we also want to promote the understanding that you don’t need an «insurance card» in order to purchase dental benefits.

WDA L egislative P riorities

“Two Cents for Tooth Sense” (Access) – The WDA coined this phrase and continues to keep the concept on legislators’ and the public’s radar, but has no current plans to reintroduce 2007 Assembly Bill 237 or Senate Bill 117 which proposed a user fee charge of approximately two cents per 12-ounce can of soda.

The amendments were agreed to in order to appease the insurance industry and get them to go neutral on the bill (which they have done): • We amended the definition of a covered service to include the standard definition of model legislation adopted in most states which means that the definition includes those services for which there would have been payment made by the plan if the following contractual limitations had not already been met: deductibles, co-pays, co-insurance, annual maximums, lifetime maximums for the same course of treatment, waiting periods, alternate benefits and frequency limitations. • We amended the definition of a plan to exclude medical plans that embed dental into their coverage - this does not include most medical insurance plans who offer dental as a separate insurance (which is the case with Anthem and the majority of dental plans that are owned and operated by larger medical insurers - they are still «limited scope dental plans» and will be captured by the bill) • Although not supported by the insurance industry, we did also include a general de minimis clause which basically says that an insurance plan should not pay a nominal or de minimis fee on a procedure in order to skirt the intent of this bill and claim they now «cover» the service. Fiscal impact to the state: $0. Marquette University School of Dentistry -

The purpose of this fee is to develop a funding source for providing dental services to the state’s MA and BadgerCare patients.

Increase the number of Wisconsin residents eligible for the program from up to 160 (40 per class) to up to 200 per class (50 per class) to be phased in over a four-year period.

Fiscal impact to the state: A dated fiscal analysis indicated that approximately $70 million a year could be raised from consumers of soda (an updated fiscal estimate may be beneficial).

MUSOD would want the 2013-2015 state budget to reflect the phase-in and provide real dollars for up to 200 Wisconsin residents with the understanding that any excess funds above the defined levels would be lapsed back each fiscal year.

Completed Items - Those issues that were on the priority agenda that have successfully passed and been signed into law or, if we oppose, have successfully been defeated and are no longer “active“ issues for the current legislative session. Non-Covered Services Legislation (2013 AB 109/SB 131/ACT 26) – The WDA actively pursued passage of legislation prohibiting dental benefit plans from setting fees for services that are not reimbursed by the benefit plan. 2011 AB 251 (which failed to pass the legislature prior to adjournment in the spring of 2012) was amended and then reintroduced as 2013 AB 109/SB 131 in the current session.

The WDA supported an increase in the number of in-state residents eligible for the tuition subsidy from 40 to 50 per class, leaving the subsidy itself at the rate of $8,665. The governor’s budget bill included $500,000 to allow for the expansion of tuition subsidies to the 10 new Wisconsin residents each year for the next four years, beginning in the fall 2013. This proposal has to make it through the legislative process and be signed into law by the governor but we anticipate this should happen without too much problem. It successfully received approval of the Joint Committee on Finance on May 23 and was signed into law when the Governor signed the budget on June 30, 2013.

Mark your calendar! The Wisconsin State Dental Golf Tournament is set for Monday, Sept. 8 2014 at the Legend at Brandybrook in Wales.

Proceeds from the event benefit the WDA Foundation.

2014 WDA Sourcebook

Wisconsin Dental Practice Act/ WI Admin Rules/FAQs

Wisconsin Dental Practice Act Chapter 447 Dentistry Examining Board

447.01 Definitions. In this chapter: (1) “Accredited” means accredited by the American Dental Association commission on dental accreditation or its successor agency. (2) “Dental disease” means any pain, injury, deformity, physical illness or departure from complete dental health or the proper condition of the human oral cavity or any of its parts. (3) “Dental hygiene” means the performance of educational, preventive or therapeutic dental services. “Dental hygiene” includes any of the following: (a) Removing supragingival or subgingival calcareous deposits, subgingival cement or extrinsic stains from a natural or restored surface of or a fixed replacement for a human tooth. (b) Deep scaling or root planing a human tooth. (c) Conditioning a human tooth surface in preparation for the placement of a sealant and placing a sealant. (d) Conducting a substantive medical or dental history interview or preliminary examination of a dental patient’s oral cavity or surrounding structures, including the preparation of a case history or recording of clinical findings. (e) Conducting an oral screening without the written prescription of a dentist. (f) Participating in the development of a dental patient’s dental hygiene treatment plan. (g) Any other practice specified in the rules promulgated under s. 447.02 (1) (d). (4) “Dental hygiene student” means an individual who is enrolled in and in regular attendance at an accredited dental hygiene school. (5) “Dental hygienist” means an individual who practices dental hygiene. (6) “Dental student” means an individual who is enrolled in and in regular attendance at an accredited dental school. (7) “Dentist” means an individual who practices dentistry. (8) “Dentistry” means the examination, diagnosis, treatment, planning or care of conditions within the human oral cavity or its adjacent tissues and structures. “Dentistry” includes any of the following: (a) Examining into the fact, condition or cause of dental health or dental disease or applying principles or techniques of dental science in the diagnosis, treatment or prevention of or prescription for any of the lesions, dental diseases, disorders or deficiencies of the human oral cavity, teeth, investing tissues, maxilla or mandible or adjacent associated structures. (b) Extracting human teeth or correcting their malposition. (c) Directly or indirectly, by mail, carrier, person or any other method, furnishing, supplying, constructing, reproducing or repairing prosthetic dentures, bridges, appliances or other structures to be used or worn as substitutes for natural human teeth; or placing such substitutes in the mouth directly or indirectly or adjusting the same; or taking, making or giving advice or

447.02 Dentistry Examining Board (1) The examining board may promulgate rules: (a) Governing the reexamination of an applicant who fails an examination specified in s. 447.04 (1) (a) 5. or (2) (a) 5. The rules may specify additional educational requirements for those applicants and may specify the number of times an applicant may be examined. (b) Governing the standards and conditions for the use of radiation and ionizing equipment in the practice of dentistry. (c) Subject to ch. 553 and s. 447.06 (1), governing dental franchising. (d) Specifying practices, in addition to the practices specified under s. 447.01 (3) (a) to (f), that are included within the practice of dental hygiene. (e) Providing for the granting of temporary licenses under this chapter. (f) Governing compliance with continuing education requirements under s. 447.056. (2) The examining board shall promulgate rules specifying all of the following: (a) The conditions for supervision and the degree of supervision required under ss. 447.03 (3) (a), (b) and (d) 2. and 447.065. (b) The standards, conditions and any educational requirements that are in addition to the requirements specified in s. 447.04 (1) that must be met by a dentist to be permitted to induce general anesthesia or conscious sedation in connection with the practice of dentistry. (c) Whether an individual is required to be licensed under this chapter to remove plaque or materia alba accretions with mechanical devices. (d) The oral systemic premedications and subgingival sustained release chemotherapeutic agents that may be administered by a dental hygienist licensed under this chapter under s. 447.06 (2) (e) 1. and 3. (e) The educational requirements for administration of local anesthesia by a dental hygienist licensed under this chapter under s. 447.06 (2) (e) 2. (3) (a) The examining board may issue a permit authorizing the practice in this state, without compensation, of dentistry or dental hygiene to an applicant who is licensed to practice dentistry or dental hygiene in another state, if all of the following apply:

Wisconsin Dental Practice Act

447.01 Definitions 447.02 Dentistry Examining Board 447.03 License required 447.04 Licensure 447.05 Expiration and renewal 447.055 Continuing education; dental hygienists 447.056 Continuing education; dentists 447.06 Practice limitations 447.065 Delegation of remediable procedures and dental practices 447.067 Identification of removable prosthetic devices 447.07 Disciplinary proceedings 447.09 Penalties 447.10 Injunction 447.11 Wisconsin Dental Association 447.12 County and district dental societies 447.13 Service insurance corporations for dental care 447.15 Definitions applicable to indemnification and insurance provisions 447.17 Mandatory indemnification 447.19 Determination of right to indemnification 447.21 Allowance of expenses as incurred 447.23 Dental society may limit indemnification 447.25 Additional rights to indemnification and allowance of expenses 447.27 Court−ordered indemnification 447.29 Indemnification and allowance of expenses of employees and agents 447.31 Insurance 447.34 Reliance by directors or officers 447.36 Consideration of interests in addition to members’ interests 447.38 Limited liability of directors and officers

assistance or providing facilities for the taking or making of any impression, bite, cast or design preparatory to, or for the purpose of, or with a view to the making, producing, reproducing, constructing, fitting, furnishing, supplying, altering or repairing of any such prosthetic denture, bridge or appliance; or taking impressions for or fitting athletic mouthguards. (d) Administering anesthetics, either general or local, while performing or claiming to perform dental services. (e) Prescribing or administering drugs in the course of or incident to the rendition of dental services, or as part of a representation that dental services have been or will be rendered. (f) Engaging in any of the practices, techniques or procedures included in the curricula of accredited dental schools. (g) Penetrating, piercing or severing the tissues within the human oral cavity or adjacent associated structures. This paragraph does not apply to care or treatment rendered by a physician, as defined in s. 448.01 (5), acting within the scope of the practice of medicine and surgery, as defined in s. 448.01 (9). (h) Developing a treatment plan for a dental patient to treat, operate, prescribe or advise for the patient by any means or instrumentality. Nothing in this paragraph prohibits a dental hygienist from participating in the development of a dental patient’s dental hygiene treatment plan. (9) “Examining board” means the dentistry examining board. (12) “Remediable procedures” means patient procedures that create changes within the oral cavity or surrounding structures that are reversible and do not involve any increased health risks to the patient. (13) “Written or oral prescription” means specific written or oral authorization by a dentist who is licensed to practice dentistry under this chapter to perform patient procedures according to a clearly defined treatment plan developed by the dentist. History: 1989 a. 56; 1989 a. 349 ss. 4, 5, 8 to 10.

1. The examining board determines that the applicant’s services will improve the welfare of Wisconsin residents. 2. The examining board determines that the applicant is qualified and satisfies the criteria specified under s. 447.04 (1) (b) 1. to 3., except that the examining board may not require the applicant to pass an examination of state statutes and rules relating to dentistry or dental hygiene. (b) A permit under this subsection shall authorize the practice of dentistry or dental hygiene in a specified area of the state for a period of time not more than 10 days in a year and may be renewed by the examining board. The examining board may not require an applicant to pay a fee for the issuance or renewal of a permit under this subsection. History: 1989 a. 349; 1997 a. 96; 2007 a. 31; 2009 a. 10. Cross−reference: See also DE and chs. DE 7 and 11, Wis. adm. code. 2014 WDA Sourcebook

Wisconsin Dental Practice Act

447.03 License required (1) DENTISTS. Except as provided under sub. (3) and ss. 257.03 and 447.02 (3), no person may do any of the following unless he or she is licensed to practice dentistry under this chapter: NOTE: Sub. (1) (intro.) is shown as affected by 2 acts of the 2009 Wisconsin legislature and as merged by the legislative reference bureau under s. 13.92 (2) (i). (a) Practice or offer to practice dentistry. (b) Use or permit to be used, directly or indirectly, for a profit or otherwise for himself or herself, or for any other person, the title, or append to his or her name the words or letters, “doctor”, “Dr.”, “Doctor of Dental Surgery”, “D.D.S.”, or “D.M.D.”, or any other letters, titles, degrees, terms or descriptive matter, personal or not, which directly or indirectly represent him or her to be engaged in the practice of dentistry. (c) Inform the public directly or indirectly in any language, orally, in writing or printing or by drawings, demonstrations, signs, pictures or other means that he or she can perform or will attempt to perform dental services of any kind. (2) DENTAL HYGIENISTS. Except as provided under sub. (3) and s. 447.02 (3), no person may do any of the following unless he or she is licensed to practice dental hygiene under this chapter: (a) Practice or offer to practice dental hygiene. (b) Represent himself or herself to the public as a dental hygienist or use, in connection with his or her name, any title or description that may convey the impression that he or she is a dental hygienist. (3) EXCEPTIONS. No license or certificate under this chapter is required for any of the following: (a) A dental student who practices dentistry under the supervision of a dentist in an infirmary, clinic, hospital or other institution connected or associated for training purposes with an accredited dental school. (b) A dental hygiene student who practices dental hygiene under the supervision of a dentist in an infirmary, clinic, hospital or other institution connected or associated for training purposes with an accredited dental hygiene school. (c) An individual licensed to practice dentistry or dental hygiene in another state or country who practices dentistry or dental hygiene in a program of dental education or research at the invitation of a group of dentists or practices dentistry or dental hygiene under the jurisdiction of the army, navy, air force, U.S. public health service or veterans bureau. (d) Any of the following individuals who do not engage in the private practice of dentistry and do not have an office outside the institution at which he or she is appointed or employed: 1. A nonclinical instructor in dental science who is employed by an accredited dental school. 2. A dental fellow engaged in dental science teaching or research who is appointed by and is under the supervision of the faculty of an accredited dental school. 3. A dental intern who is appointed by a hospital located in this state, if the hospital is accredited for dental internship training and the internship does not exceed one year. 4. A dental resident who is appointed by a hospital located in this state for a 2nd or subsequent year of advanced study of dental science if the hospital is accredited for dental residency training. (e) Any examiner representing a testing service approved by the examining board. (f) A dental laboratory or dental laboratory technician to construct appliances or restorations for dentists if all of the following apply: 1. The appliances or restorations are constructed upon receipt from a dentist of impressions or measurements, directions, and a written work authorization on a form approved by the examining board. 2. The amounts payable for the services are billed to the dentist. (g) Any individual who provides remediable procedures that are delegated under s. 447.065 (1). (h) A physician or surgeon licensed in this state who extracts teeth, or operates upon the palate or maxillary bones and investing tissues, or who administers anesthetics, either general or local. History: 1989 a. 349 ss. 15, 18; 1997 a. 96; 2005 a. 96; 2009 a. 10, 42; s. 13.92 (2) (i). 447.04 Licensure (1) DENTISTS. (a) The examining board shall grant a license to practice dentistry to an individual who does all of the following: 1. Submits an application for the license to the department on a form provided by the department. 2. Pays the fee specified in s. 440.05 (1). 3. Submits evidence satisfactory to the examining board that he or she has graduated from an accredited dental school.

2014 WDA Sourcebook

4. Submits evidence satisfactory to the examining board that he or she has passed the national dental examination and the examination of a dental testing service approved by the examining board. 5. Passes an examination administered by the examining board on the statutes and rules relating to dentistry. 5m. Submits evidence satisfactory to the examining board that he or she has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved under s. 46.03 (38) to provide such instruction. 6. Completes any other requirements established by the examining board by rule. (b) Except as provided in par. (c), the examining board may grant a license to practice dentistry to an individual who is licensed in good standing to practice dentistry in another state or territory of the United States or in another country if the applicant complies with all of the following requirements: 1. Meets the requirements for licensure established by the examining board by rule. 2. Submits evidence satisfactory to the examining board that the person has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education qualified to provide such instruction. The examining board shall consult with the department of health services to determine whether an individual, organization, or institution of higher education is qualified to provide instruction under this subdivision. 3. Presents the license to the examining board and pays the fee specified under s. 440.05 (2). (c) 1. The examining board shall grant a license to practice dentistry to an applicant who is licensed in good standing to practice dentistry in another jurisdiction upon presentation of the license and who does all of the following: a. Pays the fee specified in s. 440.05 (2). b. Submits evidence satisfactory to the examining board that the applicant has been offered employment as a full−time faculty member at a school of dentistry in this state. c. Makes responses during any interview that the examining board may require that demonstrate, to the satisfaction of the examining board, that the applicant is competent to practice dentistry. d. Submits evidence satisfactory to the examining board that the person has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education qualified to provide such instruction. The examining board shall consult with the department of health services to determine whether an individual, organization, or institution of higher education is qualified to provide instruction under this subdivision. 2. A license granted under subd. 1. authorizes the license holder to practice dentistry only within educational facilities. 3. A license granted under subd. 1. is no longer in effect if the license holder ceases to be employed as a full−time faculty member at a school of dentistry in this state. 4. The examining board may promulgate rules to carry out the purposes of this paragraph. (2) DENTAL HYGIENISTS. (a) The examining board shall grant a license to practice dental hygiene to an individual who does all of the following: 1. Submits an application for the license to the department on a form provided by the department. 2. Pays the fee specified in s. 440.05 (1). 3. Submits evidence satisfactory to the examining board that he or she has graduated from an accredited dental hygiene school. 4. Submits evidence satisfactory to the examining board that he or she has passed the national dental hygiene examination and the examination of a dental hygiene testing service approved by the examining board. 5. Passes an examination administered by the examining board on the statutes and rules relating to dental hygiene. 5m. Submits evidence satisfactory to the examining board that he or she has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved under s. 46.03 (38) to provide such instruction. 6. Completes any other requirements established by the examining board by rule. (b) The examining board may grant a license to practice dental hygiene to an individual who is licensed in good standing to practice dental hygiene in another state or territory of the United States or in another country if the applicant complies with all of the following requirements: 1. Meets the requirements for licensure established by the examining board by rule. 2. Submits evidence satisfactory to the examining board that the person has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education qualified to provide such instruction. The examining board shall consult with the

Wisconsin Dental Practice Act department of health services to determine whether an individual, organization, or institution of higher education is qualified to provide instruction under this subdivision. 3. Presents the license to the examining board and pays the fee specified under s. 440.05 (2). (c) 1. The examining board shall grant a certificate to administer local anesthesia to a dental hygienist who is licensed under par. (a) or (b), and who submits evidence satisfactory to the examining board that he or she satisfies the educational requirements established in rules promulgated under s. 447.02 (2) (e). 2. No fee may be charged for a certificate granted under subd. 1. A certificate granted under subd. 1. remains in effect while the dental hygienists’ license granted under par. (a) or (b) remains in effect unless the certificate is suspended or revoked by the examining board. History: 1989 a. 349; 1997 a. 96; 2001 a. 16, 109; 2007 a. 20 s. 9121 (6) (a); 2007 a. 104; 2009 a. 276.

447.055 Continuing education; dental hygienists (1)(a) Except as provided in subs. (3) and (4), a person is not eligible for renewal of a license to practice dental hygiene, other than a permit issued under s. 447.02 (3), unless the person has taught, prepared, attended, or otherwise completed, during the 2−year period immediately preceding the renewal date specified under s.440.08 (2) (a), 12 credit hours of continuing education relating to the clinical practice of dental hygiene that is sponsored or recognized by a local, state, regional, national, or international dental, dental hygiene, dental assisting, or medical−related professional organization. (b) Continuing education required under par. (a) may include training in all of the following: 1. Basic life support or cardiopulmonary resuscitation. Not more than 2 of the credit hours required under par. (a) may be satisfied by such training. 2. Infection control. Not less than 2 of the credit hours required under par. (a) must be satisfied by such training. (c) Biennially, beginning Jan. 1, 2007, the department shall consult with the examining board and with the department of health services regarding the number of credit hours of continuing education required for eligibility for renewal under par. (a). After consulting with the examining board and the department of health services, and notwithstanding par. (a), the department may promulgate a rule requiring not more than 20 or less than 12 credit hours of continuing education for eligibility for renewal. (d) After consultation with the examining board and with the department of health services, the department may promulgate rules requiring that continuing education credit hours under par. (a) include courses in specific clinical subjects. (2) The credit hours required under sub. (1) (a) may be satisfied by independent study, correspondence, or Internet programs or courses. (3) Subsection (1) (a) does not apply to an applicant for renewal of a license that expires on the first renewal date after the date on which the examining board initially granted the license. (4) A person may substitute credit hours of college level courses related to the practice of dental hygiene for the credit hours required under sub. (1) (a). For purposes of this subsection, one credit hour of a college level course is equivalent to 6 credit hours of continuing education. (5) For purposes of sub. (1) (a), one hour of teaching or preparing a continuing education program is equivalent to one credit hour of continuing education, but a person who teaches or prepares a continuing education program may obtain credit for the program only once. (6) The examining board may require applicants for renewal of a license to practice dental hygiene to submit proof of compliance with the requirements of this section. History: 2005 a. 318; 2007 a. 31; 2007 a. 20 s. 9121 (6) (a); 2009 a. 10.

447.06 Practice limitations (1) No contract of employment entered into between a dentist and any other party under which the dentist renders dental services may require the dentist to act in a manner which violates the professional standards for dentistry set forth in this chapter. Nothing in this subsection limits the ability of the other party to control the operation of the dental practice in a manner in accordance with the professional standards for dentistry set forth in this chapter. (2) (a) A hygienist may practice dental hygiene or perform remediable procedures only as an employee or as an independent contractor and only as follows: 1. In a dental office. 2. For a school board or a governing body of a private school or of a tribal school, as defined in s. 115.001 (15m). 3. For a school for the education of dentists or dental hygienists. 4. For a facility, as defined in s. 50.01 (1m), a hospital, as defined in s. 50.33 (2), a state or federal prison, county jail or other federal, state, county or municipal correctional or detention facility, or a facility established to provide care for terminally ill patients. 5. For a local health department, as defined in s. 250.01 (4). 6. For a charitable institution open to the general public or to members of a religious sect or order. 7. For a nonprofit home health care agency. 8. For a nonprofit dental care program serving primarily indigent, economically disadvantaged or migrant worker populations. (b) A dental hygienist may practice dental hygiene or perform remediable procedures under par. (a) 1., 4., 6., 7. or 8. only as authorized by a dentist who is licensed to practice dentistry under this chapter and who is present in the facility in which those practices or procedures are performed, except as provided in par. (c). (c) A dental hygienist may practice dental hygiene or perform remediable procedures under par. (a) 1., 4., 6., 7. or 8. if a dentist who is licensed to practice dentistry under this chapter is not present in the facility in which those practices or procedures are performed only if all of the following conditions are met: 1. The dental hygiene practices or remediable procedures are performed under a written or oral prescription. 2. The dentist who made the written or oral prescription has examined the patient at least once during the 12−month period immediately preceding: a. The date on which the written or oral prescription was made; and b. The date on which the dental hygiene practices or remediable procedures are performed. 3. The written or oral prescription specifies the practices and procedures that the dental hygienist may perform with the informed consent of the patient or, if applicable, the patient’s parent or legal guardian. 2014 WDA Sourcebook

Wisconsin Dental Practice Act

447.05 Expiration and renewal Renewal applications shall be submitted to the department on a form provided by the department on or before the applicable renewal date specified under s. 440.08 (2) (a) and shall include the applicable renewal fee determined by the department under s. 440.03 (9) (a).The examining board may not renew a license to practice dentistry unless the applicant for renewal attests that he or she has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved under s. 46.03 (38) to provide such instruction. The examining board may not renew a license to practice dental hygiene unless the applicant for renewal attests that he or she has complied with s. 447.055 and any rules promulgated by the department under s. 447.055, that he or she has a current certification in cardiopulmonary resuscitation, and that he or she has current proficiency in the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved under s.46.03 (38) to provide such instruction. History: 1989 a. 349; 1991 a. 39; 2005 a. 318; 2007 a. 20, 104; 2009 a. 180.

447.056 Continuing education; dentists (1) Except as provided in subs. (2) to (4), a person is not eligible for renewal of a license to practice dentistry, other than a permit issued under s.447.02 (3), unless the person has taught, attended, or otherwise completed, during the 2−year period immediately preceding the renewal date specified under s. 440.08 (2) (a), 30 credit hours of continuing education related to the practice of dentistry or the practice of medicine, including not less than 25 credit hours of instruction in clinical dentistry or clinical medicine. Not more than 4 of the 30 hours may be from teaching. Continuing education does not satisfy the requirements under this subsection unless the continuing education is one of the following: (a) Sponsored or recognized by a local, state, regional, national, or international dental or medical professional organization. (b) A college−level course that is offered by a postsecondary institution accredited by the American Dental Association commission on dental accreditation or a successor agency, or by another recognized accrediting body. (2) Subsection (1) does not apply to an applicant for renewal of a license that expires on the first renewal date after the date on which the examining board initially granted the license. (3) Credit hours completed before the 2−year period immediately preceding renewal of a license to practice dentistry may not be applied to fulfill the credit hours required under sub. (1). (4)) The examining board may waive the continuing education requirements under sub. (1) if it finds that exceptional circumstances such as prolonged illness, disability, or other similar circumstances have prevented a person licensed to practice dentistry from meeting the requirement. (5) A person who is licensed to practice dentistry shall keep a written record detailing each continuing education credit completed in compliance with sub. (1) and shall maintain the written record for not less than 6 years after the person completes each credit. The examining board may require applicants for renewal of a license to practice dentistry to submit proof of compliance with the requirements of this section. History: 2007 a. 31; 2009 a. 10.

Wisconsin Dental Practice Act

4. If the practices or procedures are performed in a dental office, the patient has been the dentist’s patient of record for not less than 6 months. (d) A dental hygienist may not diagnose a dental disease or ailment, determine any treatment or any regimen of any treatment outside of the scope of dental hygiene, prescribe or order medication or perform any procedure that involves the intentional cutting of soft or hard tissue of the mouth by any means. (e) Pursuant to a treatment plan approved by a dentist who is licensed under this chapter, a dental hygienist licensed under this chapter may administer the following upon delegation by the dentist if the dentist remains on the premises in which the practices are performed and is available to the patient throughout the completion of the appointment: 1. Oral systemic premedications specified by the examining board by rule. 2. If the dental hygienist is certified under s. 447.04 (2) (c) 1., local anesthesia. 3. Subgingival sustained release chemotherapeutic agents specified by the examining board by rule. History: 1989 a. 349 ss. 13, 16 to 19; 1993 a. 27; 1997 a. 96; 2009 a. 302. 447.065 Delegation of remediable procedures and dental practices (1) A dentist who is licensed to practice dentistry under this chapter may delegate to an individual who is not licensed under this chapter only the performance of remediable procedures, and only if all of the following conditions are met: (a) The unlicensed individual performs the remediable procedures in accordance with a treatment plan approved by the dentist. (b) The dentist is on the premises when the unlicensed individual performs the remediable procedures. (c) The unlicensed individual’s performance of the remediable procedures is subject to inspection by the dentist. (2) Subject to the requirements under s. 447.06 (2), a dentist who is licensed to practice dentistry under this chapter may delegate to a dental hygienist who is licensed to practice dental hygiene under this chapter the performance of remediable procedures and the administration of oral systemic premedications, local anesthesia and subgingival sustained release chemotherapeutic agents. (3) A dentist who delegates to another individual the performance of any practice or remediable procedure is responsible for that individual’s performance of that delegated practice or procedure. History: 1989 a. 349; 1997 a. 96. 447.067 Identification of removable prosthetic devices (1) Except as provided in sub. (2), a dentist who constructs a removable prosthetic device shall mark the device with the patient’s first and last name. Except as provided in sub. (2), a dentist who authorizes a dental laboratory or dental laboratory technician to construct a removable prosthetic device shall ensure that the device is marked with the patient’s first and last name. (2) The following exceptions apply to the identification required under sub. (1): (a) The first, middle and last name initials of the patient may be substituted for the first and last name of the patient if, in the professional judgment of the dentist, it is impracticable to mark the first and last name of the patient. (b) The name and the initials of the patient may be omitted if each of those forms of identification is medically contraindicated. History: 1993 a. 103. 447.07 Disciplinary proceedings (1) The examining board may, without further notice or process, limit, suspend or revoke the license or certificate of any dentist or dental hygienist who fails, within 60 days after the mailing of written notice to the dentist’s or dental hygienists’ last−known address, to renew his or her license or certificate. (3) Subject to the rules promulgated under s. 440.03 (1), the examining board may make investigations and conduct hearings in regard to any alleged action of any dentist or dental hygienist, or of any other person it has reason to believe is engaged in or has engaged in the practice of dentistry or dental hygiene in this state, and may, on its own motion, or upon complaint in writing, reprimand any dentist or dental hygienist who is licensed or certified under this chapter or deny, limit, suspend or revoke his or her license or certificate if it finds that the dentist or dental hygienist has done any of the following: (a) Engaged in unprofessional conduct. (b) Made any false statement or given any false information in connection with an application for a license or certificate or for renewal or reinstatement of a license or certificate or received a license or certificate through error. (c) Been adjudicated mentally incompetent by a court. (d) Directly or indirectly sent, for a purpose other than shade verification, impressions or

2014 WDA Sourcebook

measurements to a dental laboratory without a written work authorization on a form approved by the examining board and signed by the authorizing dentist, or directly or indirectly sent a patient, or an agent of a patient, to a dental laboratory for any purpose other than for shade verification. The examining board or its agents or employees may inspect dental offices and the work authorization records of dental laboratories to determine compliance with this paragraph. (e) Subject to ss. 111.321, 111.322 and 111.335, been convicted of a crime, the circumstances of which substantially relate to the practice of dentistry or dental hygiene. (f) Violated this chapter or any federal or state statute or rule which relates to the practice of dentistry or dental hygiene. (g) Subject to ss. 111.321, 111.322 and 111.34, practiced dentistry or dental hygiene while his or her ability was impaired by alcohol or other drugs. (h) Engaged in conduct that indicates a lack of knowledge of, an inability to apply or the negligent application of, principles or skills of dentistry or dental hygiene. (i) Obtained or attempted to obtain compensation by fraud or deceit. (j) Employed, directly or indirectly, any unlicensed or uncertified person to perform any act requiring licensure or certification under this chapter. (k) Engaged in repeated irregularities in billing a third party for services rendered to a patient. In this paragraph, “irregularities in billing” includes: 1. Reporting charges for the purpose of obtaining a total payment in excess of that usually received for the services rendered. 2. Reporting incorrect treatment dates for the purpose of obtaining payment. 3. Reporting charges for services not rendered. 4. Incorrectly reporting services rendered for the purpose of obtaining payment. 5. Abrogating the copayment provisions of a contract by agreeing to forgive any or all of the patient’s obligation for payment under the contract. (L) Violated ch. 450 or 961. (m) Made a substantial misrepresentation in the course of practice that was relied upon by a client. (n) Violated any order of the examining board. (o) Advertised by using a statement that tends to deceive or mislead the public. (5) The examining board may reinstate a license or certificate that has been voluntarily surrendered or revoked on terms and conditions that it considers appropriate. This subsection does not apply to a license that is revoked under s. 440.12. (7) In addition to or in lieu of a reprimand or denial, limitation, suspension or revocation of a license or certificate under sub. (3), the examining board may assess against an applicant, licensee or certificate holder a forfeiture of not more than $5,000 for each violation enumerated under sub. (3). History: 1975 c. 94 s. 91 (12); 1977 c. 29; 1977 c. 418; 1979 c. 162; 1981 c. 65, 380; 1981 c. 391 ss. 169, 211; 1983 a. 289; 1985 a. 29, 146; 1987 a. 316; 1989 a. 349;1995 a. 448; 1997 a. 96, 97, 237. 447.09 Penalties Any person who violates this chapter may be fined not more than $1,000 or imprisoned for not more than one year in the county jail or both for the first offense and is guilty of a Class I felony for the 2nd or subsequent conviction within five years. History: 1989 a. 349; 1997 a. 283; 2001 a. 109. 447.10 Injunction If it appears upon the complaint of any person to the examining board, or it is believed by the examining board that any person is violating this chapter, the examining board, or the district attorney of the proper county, may investigate such alleged violation, and may, in addition to or in lieu of any other remedies provided by law, bring action in the name and on behalf of the state against any such person to enjoin such violation. Between meetings of the examining board, its president and secretary, acting in its behalf, are empowered jointly to make such an investigation, and on the basis thereof to seek such relief. Investigations conducted by the examining board, or by its president and secretary, shall be conducted according to rules promulgated under s. 440.03 (1). History: 1977 c. 418. 447.11 Wisconsin Dental Association The Wisconsin Dental Association is continued with the general powers of a domestic nonstock corporation. It may take by purchase or gift and hold real and personal property. It may adopt, alter and enforce bylaws and rules for the admission and expulsion of members, the election of officers and the management of its affairs. History: 1989 a. 349.

Wisconsin Dental Practice Act

447.13 Service insurance corporations for dental care The Wisconsin Dental Association or, in a manner and to the extent approved by the Wisconsin Dental Association, a county or district dental society, may establish in one or more counties a service insurance corporation for dental care under ch. 613. History: 1975 c. 223; 1989 a. 349. 447.15 Definitions applicable to indemnification and insurance provisions In ss. 447.15 to 447.31: (1) “Dental society” means a county or district dental society organized or continued under s. 447.12. (2) “Director or officer” means any of the following: (a) A natural person who is or was a director or officer of a dental society. (b) A natural person who, while a director or officer of a dental society, is or was serving at the dental society’s request as a director, officer, partner, trustee, member of any governing or decision− making committee, employee or agent of another dental society or corporation, partnership, joint venture, trust or other enterprise. (c) A natural person who, while a director or officer of a dental society, is or was serving an employee benefit plan because his or her duties to the dental society also imposed duties on, or otherwise involved services by, the person to the plan or to participants in or beneficiaries of the plan. (d) Unless the context requires otherwise, the estate or personal representative of a director or officer. (3) “Expenses” include fees, costs, charges, disbursements, attorney fees and any other expenses incurred in connection with a proceeding. (4) “Liability” includes the obligation to pay a judgment, settlement, forfeiture, or fine, including any excise tax assessed with respect to an employee benefit plan, plus costs, fees, and surcharges imposed under ch. 814, and reasonable expenses. (5) “Party” means a natural person who was or is, or who is threatened to be made, a named defendant or respondent in a proceeding. (6) “Proceeding” means any threatened, pending or completed civil, criminal, administrative or investigative action, suit, arbitration or other proceeding, whether formal or informal, which involves foreign, federal, state or local law and which is brought by or in the right of the dental society or by any other person. History: 1987 a. 13; 2003 a. 139. 447.17 Mandatory indemnification (1) A dental society shall indemnify a director or officer, to the extent he or she has been successful on the merits or otherwise in the defense of a proceeding, for all reasonable expenses incurred in the proceeding if the director or officer was a party because he or she is a director or officer of the dental society.

(2) (a) In cases not included under sub. (1), a dental society shall indemnify a director or officer against liability incurred by the director or officer in a proceeding to which the director or officer was a party because he or she is a director or officer of the dental society, unless liability was incurred because the director or officer breached or failed to perform a duty he or she owes to the dental society and the breach or failure to perform constitutes any of the following: 1. A willful failure to deal fairly with the dental society or its members in connection with a matter in which the director or officer has a material conflict of interest. 2. A violation of criminal law, unless the director or officer had reasonable cause to believe his or her conduct was lawful or no reasonable cause to believe his or her conduct was unlawful. 3. A transaction from which the director or officer derived an improper personal profit. 4. Willful misconduct. (b) Determination of whether indemnification is required under this subsection shall be made under s. 447.19. (c) The termination of a proceeding by judgment, order, settlement or conviction, or upon a plea of no contest or an equivalent plea, does not, by itself, create a presumption that indemnification of the director or officer is not required under this subsection. (3) A director or officer who seeks indemnification shall make a written request to the dental society. (4) (a) Indemnification under this section is not required to the extent limited by the dental society’s articles, constitution or bylaws under s. 447.23. (b) Indemnification under this section is not required if the director or officer has previously received indemnification or allowance of expenses from any person, including the dental society, in connection with the same proceeding. History: 1987 a. 13. Cooperative indemnification. La Rowe and Weine. WBB Sept. 1988. 447.19 Determination of right to indemnification Unless otherwise provided by the articles, constitution or bylaws or by written agreement between the director or officer and the dental society, the director or officer seeking indemnification under s. 447.17 (2) shall select one of the following means for determining his or her right to indemnification: (1) By majority vote of a quorum of the board of directors consisting of directors not at the time parties to the same or related proceedings. If a quorum of disinterested directors cannot be obtained, by majority vote of a committee duly appointed by the board of directors and consisting solely of 2 or more directors not at the time parties to the same or related proceedings. Directors who are parties to the same or related proceedings may participate in the designation of members of the committee. (2) By independent legal counsel selected by a quorum of the board of directors or its committee in the manner prescribed in sub. (1) or, if unable to obtain such a quorum or committee, by a majority vote of the full board of directors, including directors who are parties to the same or related proceedings. (3) By a panel of 3 arbitrators consisting of one arbitrator selected by those directors entitled under sub. (2) to select independent legal counsel, one arbitrator selected by the director or officer seeking indemnification and one arbitrator selected by the 2 arbitrators previously selected. (4) By an affirmative vote of a majority of members who are entitled to vote and who are present in person or represented by proxy at a meeting at which a quorum is present, if there are members having voting rights. Unless the articles, constitution or bylaws provide otherwise, members holding one−tenth of the votes entitled to be cast, present in person or represented by proxy, shall constitute a quorum at a meeting of members. Membership rights owned by, or voted under the control of, persons who are at the time parties to the same or related proceedings, whether as plaintiffs or defendants or in any other capacity, may not be voted in making the determination. (5) By a court under s. 447.27. (6) By any other method provided for in any additional right to indemnification permitted under s. 447.25. History: 1987 a. 13.

Wisconsin Dental Practice Act

447.12 County and district dental societies (1) The dentists of any county who are licensed to practice dentistry under this chapter, provided there are at least 5 in the county, may organize a county dental society as a component of the Wisconsin Dental Association. When so organized it shall be a body corporate, and shall be designated as the dental society of the county and shall have the general powers of a corporation and may take by purchase or gift and hold real and personal property. County dental societies now existing are continued with the powers and privileges conferred by this chapter. A county or district dental society that was in existence but unincorporated on Sept. 29, 1963, is not required to incorporate unless that is the express wish of the majority of its members. (2) Persons who hold the degree of doctor of dental surgery, or its equivalent, and any other persons who have been licensed by the examining board to practice dentistry in this state, shall be eligible to meet for the organization of or to become members of a county dental society. (3) If there are not a sufficient number of dentists in a given county to form a dental society under sub. (1), those residing in the county may unite with those of adjoining counties and organize a multicounty or district dental society as a component of the Wisconsin Dental Association. The organizational meeting shall be held at the time and place agreed upon in writing by a majority of those eligible to belong. (4) A county or district dental society may adopt, alter and enforce articles and bylaws, or a constitution and bylaws for the admission and expulsion of members, the election of officers and the management of its affairs, but no instrument or action on the part of the society is valid if it is inconsistent with the articles, bylaws or policies of the Wisconsin Dental Association, or if it violates the autonomy of any other component of the Wisconsin Dental Association. Any county or district dental society which incorporates after September 29, 1963, shall file its articles as provided in ch. 181. History: 1989 a. 349.

447.21 Allowance of expenses as incurred Upon written request by a director or officer who is a party to a proceeding, a dental society may pay or reimburse his or her reasonable expenses as incurred if the director or officer provides the dental society with all of the following: (1) A written affirmation of his or her good faith belief that he or she has not breached or failed to perform his or her duties to the dental society. (2) A written undertaking, executed personally or on his or her behalf, to repay the allowance and, if required by the dental society, to pay reasonable interest on the allowance to the extent that it is ultimately determined under s. 447.19 that indemnification under s. 447.17 2014 WDA Sourcebook

Wisconsin Dental Practice Act (2) is not required and that indemnification is not ordered by a court under s. 447.27 (2) (b). The undertaking under this subsection shall be an unlimited general obligation of the director or officer and may be accepted without reference to his or her ability to repay the allowance. The undertaking may be secured or unsecured. History: 1987 a. 13.

Wisconsin Dental Practice Act

447.23 Dental society may limit indemnification (1) A dental society’s obligations to indemnify under s. 447.17 may be limited as follows: (a) If the dental society is organized before June 13, 1987, except as provided in s. 447.12 (4), by an amendment to its articles, constitution or bylaws which becomes effective on or after June 13, 1987. (b) If the dental society is organized on or after June 13, 1987, except as provided in s. 447.12 (4), by its articles, constitution or bylaws, including any amendments to its articles, constitution or bylaws. (2) A limitation under sub. (1) applies if the first alleged act of a director or officer for which indemnification is sought occurred while the limitation was in effect. History: 1987 a. 13. 447.25 Additional rights to indemnification and allowance of expenses (1) Except as provided in sub. (2), ss. 447.17 and 447.21 do not preclude any additional right to indemnification or allowance of expenses that a director or officer may have under any of the following: (a) The articles, constitution or bylaws. (b) A written agreement between the director or officer and the dental society. (c) A resolution of the board of directors. (d) A resolution, after notice, adopted by a majority vote of members who are entitled to vote. (2) Regardless of the existence of an additional right under sub. (1), the dental society may not indemnify a director or officer, or permit a director or officer to retain any allowance of expenses unless it is determined by or on behalf of the dental society that the director or officer did not breach or fail to perform a duty he or she owes to the dental society which constitutes conduct under s. 447.17 (2) (a) 1., 2., 3. or 4. A director or officer who is a party to the same or related proceeding for which indemnification or an allowance of expenses is sought may not participate in a determination under this subsection. (3) Sections 447.15 to 447.31 do not affect a dental society’s power to pay or reimburse expenses incurred by a director or officer in any of the following circumstances: (a) As a witness in a proceeding to which he or she is not a party. (b) As a plaintiff or petitioner in a proceeding because he or she is or was an employee, agent, director or officer of the dental society. History: 1987 a. 13. 447.27 Court−ordered indemnification (1) Except as provided otherwise by written agreement between the director or officer and the dental society, a director or officer who is a party to a proceeding may apply for indemnification to the court conducting the proceeding or to another court of competent jurisdiction. Application shall be made for an initial determination by the court under s. 447.19 (5) or for review by the court of an adverse determination under s. 447.19 (1), (2), (3), (4) or (6). After receipt of an application, the court shall give any notice it considers necessary. (2) The court shall order indemnification if it determines any of the following: (a) That the director or officer is entitled to indemnification under s. 447.17 (1) or (2). If the court also determines that the dental society unreasonably refused the director’s or officer’s request for indemnification, the court shall order the dental society to pay the director’s or officer’s reasonable expenses incurred to obtain the court−ordered indemnification. (b) That the director or officer is fairly and reasonably entitled to indemnification in view of all the relevant circumstances, regardless of whether indemnification is required under s. 447.17 (2). History: 1987 a. 13. 447.29 Indemnification and allowance of expenses of employees and agents A dental society may indemnify and allow reasonable expenses of an employee or agent who is not a director or officer to the extent provided by the articles, constitution or bylaws, by general or specific action of the board of directors or by contract. History: 1987 a. 13.

2014 WDA Sourcebook

447.31 Insurance A dental society may purchase and maintain insurance on behalf of an individual who is an employee, agent, director or officer of the dental society against liability asserted against and incurred by the individual in his or her capacity as an employee, agent, director or officer, or arising from his or her status as an employee, agent, director or officer, regardless of whether the dental society is required or authorized to indemnify or allow expenses to the individual against the same liability under ss. 447.17, 447.21, 447.25 and 447.29. History: 1987 a. 13. 447.34 Reliance by directors or officers Unless the director or officer has knowledge that makes reliance unwarranted, a director or officer of a county or district dental society organized or continued under s. 447.12 may, in discharging his or her duties to the dental society, rely on information, opinions, reports or statements, any of which may be written or oral, formal or informal, including financial statements and other financial data, if prepared or presented by any of the following: (1) An officer or employee of the dental society whom the director or officer believes in good faith to be reliable and competent in the matters presented. (2) Legal counsel, certified public accountants licensed under ch. 442, or other persons as to matters the director or officer believes in good faith are within the person’s professional or expert competence. (3) In the case of reliance by a director, a committee of the board of directors of which the director is not a member if the director believes in good faith that the committee merits confidence. History: 1987 a. 13; 2001 a. 16. 447.36 Consideration of interests in addition to members’ interests In discharging his or her duties to a county or district dental society organized or continued under s. 447.12 and in determining what he or she believes to be in the best interests of the dental society, a director or officer may, in addition to considering the effects of any action on members, consider the following: (1) The effects of the action on employees, suppliers and customers of the dental society. (2) The effects of the action on communities in which the dental society operates. (3) Any other factors the director or officer considers pertinent. History: 1987 a. 13. 447.38 Limited liability of directors and officers (1) Except as provided in subs. (2) and (3), a director or officer of a county or district dental society organized or continued under s. 447.12 is not liable to the dental society, its members or creditors, or any person asserting rights on behalf of the dental society, its members or creditors, or any other person, for damages, settlements, fees, fines, penalties or other monetary liabilities arising from a breach of, or failure to perform, any duty resulting solely from his or her status as a director or officer, unless the person asserting liability proves that the breach or failure to perform constitutes any of the following: (a) A willful failure to deal fairly with the dental society or its members in connection with a matter in which the director or officer has a material conflict of interest. (b) A violation of criminal law, unless the director or officer had reasonable cause to believe his or her conduct was lawful or no reasonable cause to believe his or her conduct was unlawful. (c) A transaction from which the director or officer derived an improper personal profit. (d) Willful misconduct. (2) Except as provided in sub. (3), this section does not apply to any of the following: (a) A civil or criminal proceeding brought by or on behalf of any governmental unit, authority or agency. (b) A proceeding brought by any person for a violation of state or federal law where the proceeding is brought pursuant to an express private right of action created by state or federal statute. (3) Subsection (2) does not apply to a proceeding brought by a governmental unit, authority or agency in its capacity as a private party or contractor. History: 1987 a. 13. Cooperative indemnification. La Rowe and Weine. WBB Sept. 1988.

Wisconsin Administrative Rules DENTISTRY EXAMINING BOARD The Dentistry Examining Board is currently comprised of 11 members (six dentists, three dental hygienists and two public members) who are appointed by the governor with the advice and consent of the state Senate. License renewal fees the state collects from dentists and dental hygienists every two years (due by October 1 of each odd-numbered year) are used to support the day-to-day regulatory activity and the staff members needed to complete its work in the regulatory area. The DEB is responsible for issuing licenses and for determining what disciplinary actions should be taken if dentists or dental hygienists fail to comply with the state’s rules and regulations relating to dentistry. The DEB is also responsible for promulgating specific rules governing the practice of dentistry in the state of Wisconsin. The DEB is granted statutory authority by the Wisconsin Legislature to promulgate administrative rules which govern specific areas of dentistry in the state. Administrative rules must be compatible with statutes (specifically with Chapter 447); administrative rules tend to be more specific in nature and can be amended much more easily than the provisions in Chapter 447 of the state statutes. Position papers are available online on the following topics: • Conscious sedation advertising • Laser use by dental hygienists • Teeth whitening • Use of dermal fillers and Botox®

CHAPTER DE 1 Note: Chapter DE 1 as it existed on February 28, 1982 was repealed and a new chapter DE 1 was created effective March 1, 1982. DE 1.01 Authority. The provisions in chs. DE 1 to 12 are adopted pursuant to authority in ss. 15.08 (5) and 227.11 (2) (a), Stats., and ch. 447, Stats. History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; am. Register, August, 1991, No. 428, eff. 9-1-91. DE 1.02 Definitions. As used in rules of the dentistry examining board: (1) “Accredited” means accredited by the American dental association commission on dental accreditation or its successor agency. (1m) “Active practice of dental hygiene” means having engaged in at least 350 hours of the practice of dental hygiene in the 12-month period preceding application for licensure in Wisconsin in private practice, the armed forces of the United States, the United States public health service, or as a clinical instructor in a school of dental hygiene accredited by the American dental association, with a current license to practice dental hygiene in that jurisdiction. Note: The requirement of “a current license to practice dental hygiene in the jurisdiction” applies to clinical instructors at schools accredited by the American dental association, and not to persons practicing with the United States armed forces or public health service because persons practicing with the armed forces or the public health service of the United States have a current license in some U.S. jurisdiction as a condition precedent to practice under the auspices of the federal government. (2) “Active practice of dentistry” means having engaged in at least 750 hours of the practice of dentistry within the 12-month period preceding application for licensure in Wisconsin. Hours of practice must be performed in private practice, accredited postdoctoral dental residency training, the armed forces of the United States, the United States public health service, or as a licensed clinical instructor in a school of dentistry accredited by the Commission on Dental Accreditation of the American Dental Association. (3) “Board” means the dentistry examining board. (4) “Clinical and laboratory demonstration” means a comprehensive examination approved by the board consisting of a demonstration of skills, operative and restorative techniques and practical application of the basic principles of the practice of dentistry or a comprehensive examination approved by the board consisting of a written part and a demonstration of skills, techniques and practical application of the basic principles of the practice of dental hygiene.

DENTIST MEMBERS Dr. Lyndsay Knoell, Chair 5707 Byrd Ave Racine, WI 53406 262-637-7276 Term expiration: 2014

DENTAL HYGIENE MEMBERS Sandra Linhart, RDH, Secretary 2102 State Road 16 La Crosse, WI 54601 608-781-2822 Term expiration: 2014

Dr. Mark Braden, Vice Chair 101 Broad St., Ste. 203 Lake Geneva, WI 53147 Term expiration: 2014

Deb Beres, RDH 1856 Jeffery Lane Waukesha, WI 53186 414- 587-6544 Term expiration: 2016

Dr. Leonardo Huck 318 Crescent Lane Thiensville, WI 53092 Term expiration: 2017 Dr. Timothy McConville 7017 Old Sauk Road Madison, WI 53717 Term expiration: 2017 Dr. Wendy Pietz 4600 W Loomis Rd, Ste 220 Milwaukee, WI 53220 414-281-1881 Term expiration: 2017 Dr. Beth Welter 114 E. Blackhawk Ave. Prairie du Chien, WI 53821 608-326-7445 Term expiration: 2014

Eileen Donohoo, RDH 815 N. 75th St. Wauwatosa, WI 53213 414-744-1526 Term expiration: 2014 PUBLIC MEMBERS Two vacant public member seats* STAFF FOR DEB Brittany Lewin, Executive Director 1400 E. Washington Ave. Madison, WI 53702 608-261-5046 * Contact WDA Director of Government Services Mara Brooks at mbrooks@wda.org or 888-538-8932 for more information on public member seats.

(5) “Department” means the department of safety and professional services. (6) “Examination” means a comprehensive, written examination approved by the board on the basic principles of the practices of dentistry or dental hygiene. (7) “Practice of dental hygiene” means the application of skills to render educational, preventive and therapeutic services not in conflict with the practice of dentistry as defined in s. 447.01 (8), Stats. (8) “Supervision” means the direction of the practice of dental hygiene, as specified in s. DE 3.02, by a licensed dentist.

Wisconsin Administrative Rules

The general public or members of the dental profession can ask the members of the DEB to address specific issues by writing to the DEB at the Department of Safety and Professional Services, 1400 East Washington Avenue, Madison, WI 53702. You can also call DEB Executive Director Brittany Lewin at 608-261-5046. Dentists also may find helpful information on the Department of Safety and Professional Services’ website: http://dsps.wi.gov.

DEB MEMBERS

History: Cr. Register, February, 1982, No. 314, eff. 3-1-82, am. (intro.), renum, (1) to (7) to be (2) to (8) and am. (2), cr. (1), Register, August, 1991, No. 428, eff. 9-1-91. Chapter DE 2 LICENSURE Note: Chapter DE 2 as it existed on February 28, 1982, was repealed and a new chapter DE 2 was created effective March 1, 1982. DE 2.01 Application for license. (1) An applicant for license as a dentist shall submit all of the following to the board: (a) An application on a form approved by the board. (c) The fee authorized by s. 440.05 (1), Stats. (d) Evidence of successful completion of an examination on provisions in ch. 447, Stats., and chs. DE 1 to 9. (e) Evidence satisfactory to the board of having graduated from an accredited dental school. (f) Verification from the commission on national examinations of the American dental association or other board-approved professional testing services of successful completion of an examination. (g) Verification from the central regional dental testing service or other board-approved testing services of successful completion of an examination in clinical and laboratory demonstrations taken within the 5-year period immediately preceding application. In this paragraph, “successful completion” means an applicant has passed all parts of the examination in no more than 3 attempts on any one part, as required in s. DE 2.09. Note: Application forms are available upon request to the board office at 1400 East 2014 WDA Sourcebook

Wisconsin Administrative Rules Washington Avenue, P. O. Box 8935, Madison, Wisconsin 53708. (1m) An applicant for a license as a dentist who is a graduate of a foreign dental school shall submit all of the following to the board: (a) Evidence satisfactory to the board of having graduated from a foreign dental school. (b) The information required in sub. (1) (a) to (d), (f) and (g). (c) Evidence of the successful completion of an accredited postgraduate program in advanced education in general dentistry or an accredited general dental practice residency. (2) An applicant for license as a dental hygienist shall meet requirements in sub. (1) (a) through (d) and shall also submit to the board: (a) Verification from the commission on national examinations of the American dental association or other board-approved professional testing service of successful completion of an examination on the basic principles of the practice of dental hygiene; and (b) Verification from the central regional dental hygiene testing service or other board-approved testing service of successful completion of an examination in clinical and laboratory demonstrations taken within the 5-year period immediately preceding application.

Wisconsin Administrative Rules

History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; am. (1) (g), Register, May, 1984, No. 341, eff. 6-1-84; am. (1) (e), Register, March, 1988, No. 387, eff. 4-1-88; am. (1) (e) and (2) (intro.), Register, June, 1995, No. 474, eff. 7-1-95; am. (1) (intro.), (a), (c), (e), (f) and r. (1) (b), Register, April, 1999, No. 520, eff. 5-1-99; am. (1) (g), Register, June, 2001, No. 546, eff. 7-1-01; CR 09-007: am. (1) (e), cr. (1m) Register October 2009 No. 646, eff. 11-1-09. DE 2.015 Faculty license. (1) The board shall grant a license to practice dentistry to an applicant who is licensed in good standing to practice dentistry in another jurisdiction approved by the board upon presentation of the license and who does all of the following: (a) Submits an application on a form provided by the board. (b) Pays the fee specified in s. 440.05 (2), Stats. (c) Submits a written certification from an accredited post-doctoral dental residency training program or accredited school of dentistry in this state that the applicant has been offered employment as a full-time faculty member in that program or at that school of dentistry. (d) Submits to an initial interview and any other interview that the board may require that demonstrates, to the boardâ&#x20AC;&#x2122;s satisfaction, that the applicant is competent to practice dentistry. (e) Discloses all discipline which has ever been taken against the applicant in any jurisdiction. (2) A license granted under sub. (1) authorizes the license holder to do all of the following: (a) Practice dentistry only within the primary educational facility affiliated with an accredited post-doctoral dental residency training program or accredited school of dentistry in this state. (b) Perform dental procedures that are incident to instruction while at a site affiliated with an accredited post-doctoral dental residency training program or accredited school of dentistry located in this state. (3) A license granted under sub. (1) shall not be transferable to another accredited school of dentistry in this state or accredited post-doctoral dental residency training program without prior approval by the board. (4) A license granted under sub. (1) is no longer in effect if the license holder ceases to be employed as a full-time faculty member at an accredited post-doctoral dental residency training program or accredited school of dentistry in this state. The license holder shall notify the board in writing within 30 days of the date on which his or her employment as a licensed faculty member under sub. (1) is terminated. Note: Application forms are available upon request to the Dentistry Examining Board, 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708. History: CR 02-139: cr. Register December 2003 No. 576, eff. 1-1-04; CR 11-034: am. (1) (c), (2) (a), (b), (3), (4) Register July 2012 No. 679, eff. 8-1-12. DE 2.02 Duration of license. (1) Every person granted a license as a dentist shall be deemed licensed for the current biennial license period. (2) Every person granted a license as a dental hygienist shall be deemed licensed for the current biennial license period. (3) Licensees shall qualify biennially for renewal of license.

2014 WDA Sourcebook

History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; am. (2), Register, June, 1995, No. 474, eff. 7-1-95; am. Register, April, 1999, No. 520, eff. 5-1-99. DE 2.03 Biennial renewal. (1) Requirements for renewal; dentists. To renew a license a dentist shall, by October 1 of the odd-numbered year following initial licensure and every 2 years thereafter, file with the board all of the following: (a) An application for renewal on a form prescribed by the department. (b) The fee authorized by s. 440.08 (2), Stats. (c) Evidence satisfactory to the board that the licensee has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator, achieved through instruction provided by an individual, organization, or institution of higher education approved by the Wisconsin department of health services. (d) Except as provided in sub. (4), evidence satisfactory to the board of successful completion of the continuing education credit hours required under ch. DE 13. (2) Requirements for renewal; dental hygienists. A dental hygienist shall by October 1 of the odd-numbered year following initial licensure and every 2 years thereafter, meet the requirements for renewal specified in sub. (1) (a) to (d). (3) Failure to meet requirements. A dentist or dental hygienist who fails to meet the requirements under subs. (1) (a) to (d) and (2) by the renewal date shall cease and desist from dental or dental hygiene practice. (4) New licensees. Dentists and dental hygienists are not required to satisfy the continuing education requirements under sub. (1) (d) for the first renewal period following the issuance of their initial licenses. (5) Requirements for late renewal; reinstatement. (a) A dentist or dental hygienist who files an application for renewal of a license within 5 years after the renewal date may renew his or her license by filing with the board all of the following: 1. An application for renewal on a form prescribed by the department. 2. The fee authorized by s. 440.08 (2), Stats., plus the applicable late renewal fee authorized by s. 440.08 (3), Stats. 3. Evidence satisfactory to the board that the licensee has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator, achieved through instruction provided by an individual, organization, or institution of higher education approved by the department of health services. 4. Except as provided under sub. (4), evidence satisfactory to the board of successful completion of the continuing education credit hours required under ch. DE 13. (b) A dentist or dental hygienist who files an application for renewal more than 5 years after the renewal date may be reinstated by filing with the board an application and fees as specified in subs. (1) and (2) and verification of successful completion of examinations or education, or both, as the board may prescribe. (6) Reinstatement following disciplinary action. A dentist or dental hygienist applying for licensure following disciplinary action by the board, pursuant to s. 447.07, Stats., may be reinstated by filing with the board: (a) An application as specified in s. DE 2.01; (b) The fee authorized by s. 440.05 (1), Stats.; (c) Verification of successful completion of examinations as the board may prescribe; and, (d) Evidence satisfactory to the board, either orally or in writing as the board deems necessary, that reinstatement to practice will not constitute a danger to the public or a patient. (7) Display of license. The license and certificate of registration shall be displayed in a prominent place by every person licensed and currently registered by the board. History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; correction in (6) (b) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1986, No. 364; am. (1) (intro.), (b), (2), (5) (a) (intro.), 2., (b), (6) (intro.) and (7), r. (4), Register, June, 1995, No. 474, eff. 7-1-95; am. (1) (intro.), (2), Register, June, 1996, No. 486, eff. 7-1-96; am. (1) (b), (5) (a) 2. and (6) (b), Register, April, 1999, No. 520, eff. 5-1-99; CR 11-033: am. (1) (intro.), (a), cr. (1) (d), am. (2), (3), cr. (4), am. (5) (a) (intro.), 1., cr. (5) (a) 4. Register July 2012 No. 679, eff. 8-1-12.; CR 11-035: am. (1) (intro.), (a), cr. (1) (c), am. (5) (a) (intro.), 1., cr. (5) (a) 3. Register July 2012 No. 679, eff. 8-1-12. DE 2.04 Endorsement. (1) The board may grant a license as a dentist to an applicant who holds a valid license issued by the proper authorities of any other jurisdiction of the United States or

Wisconsin Administrative Rules (2) (c) and (d) to be (1) (d) and (f), (2) (d) and (e) and am. (1) (f), (2) (d) and (e), am. (1) (e), cr. (1) (c) and (2) (c), Register, August, 1987, No. 380, 9-1-87; am. (1) and (2), cr. (1) (g) to (i) and (2) (f) to (i), Register, August, 1991, No. 428, eff. 9-1-91; emerg. r. and recr. (1) (ed), eff. 3-18-97; am. (1) (intro.), (c) (e), (2) (intro.), (c) and (d), Register, April, 1999, No. 520, eff. 5-1-99; CR 09-007: am. (1) (a) Register October 2009 No. 646, eff. 11-1-09; CR 11-034: am. (1) (e) Register July 2012 No. 679, eff. 8-1-12; CR 11-035: am. (1) (g), (h), (2) (a), (g), (h) Register July 2012 No. 679, eff. 8-1-12. DE 2.05 Examination passing score. The score required to pass an examination shall be based on the board’s determination of the level of examination performance required for minimum acceptable competence in the profession. The board shall make the determination after consultation with subject matter experts who have reviewed a representative sample of the examination questions and available candidate performance statistics, and shall set the passing score for the examination at that point which represents minimum acceptable competence in the profession. History: Cr. Register, April, 1999, No. 520, eff. 5-1-99. DE 2.06 Unauthorized assistance. An applicant may not give or receive unauthorized assistance during the examination. The action taken by the board when unauthorized assistance occurs shall be related to the seriousness of the offense. These actions may include withholding the score of the applicant, entering a failing grade for the applicant, and suspending the ability of the applicant to sit for the next scheduled examination after the examination in which the unauthorized assistance occurred. History: Cr. Register, April, 1999, No. 520, eff. 5-1-99. DE 2.07 Examination review. (1) An applicant who fails an examination administered by the board may request a review of that examination by filing a written request to the board within 30 days after the date on which the examination results were mailed to the applicant. (2) An examination review shall be conducted under the following conditions: (a) The time for review shall be limited to one hour. (b) The examination shall be reviewed only by the applicant and in the presence of a proctor. (c) The proctor may not respond to inquiries by the applicant regarding allegations of examination error. (d) Any comments or claims of error regarding specific questions or procedures in the examination may be placed in writing by the applicant on the form provided for this purpose. The request shall be reviewed by the board in consultation with a subject matter expert. The applicant shall be notified in writing of the board’s decision. (e) An applicant shall be permitted only one review of the failed examination each time it is taken and failed. Note: The board office is located at 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708.

Wisconsin Administrative Rules

Canada upon payment of the fee authorized by s. 440.05 (2), Stats., and submission of evidence satisfactory to the board that all of the following conditions are met: (a) The applicant has graduated from an accredited school of dentistry or the applicant has graduated from a foreign dental school and has successfully completed an accredited postgraduate program in advanced education in general dentistry or an accredited general dental practice residency. (b) The applicant submits a certificate from each jurisdiction in which the applicant is or has ever been licensed stating that no disciplinary action is pending against the applicant or the license, and detailing all discipline, if any, which has ever been imposed against the applicant or the license. (c) The applicant has not failed the central regional dental testing service clinical and laboratory demonstration examination, or any other dental licensing examination, within the previous 3 years. (d) The applicant has been engaged in the active practice of dentistry, as defined in s. DE 1.02 (2), in one or more jurisdictions in which the applicant has a current license in good standing, for at least 48 of the 60 months preceding the application for licensure in Wisconsin. (e) The applicant has successfully completed a clinical and laboratory demonstration licensing examination on a human subject which, in the board’s judgment, is substantially equivalent to the clinical and laboratory demonstration examination administered by the central regional dental testing service, or, alternatively, has successfully completed a board specialty certification examination in a dental specialty recognized by the American Dental Association. (f) The applicant has successfully completed a jurisprudence examination on the provisions of Wisconsin statutes and administrative rules relating to dentistry and dental hygiene. (g) The applicant possesses a current certificate of proficiency in cardiopulmonary resuscitation from a course provider approved by the Wisconsin department of health services. (h) The applicant has disclosed all discipline which has ever been taken against the applicant in any jurisdiction shown in reports from the national practitioner data bank and the American Association of Dental Boards. (i) The applicant has presented satisfactory responses during any personal interview with the board which may be required to resolve conflicts between the licensing standards and the applicant’s application. (2) The board may grant a license as a dental hygienist to an applicant who holds a license issued by the proper authorities of any other jurisdiction of the United States or Canada upon payment of the fee authorized by s. 440.05 (2), Stats., and submission of evidence satisfactory to the board that all of the following conditions are met: (a) The applicant has graduated from a school of dental hygiene accredited by the Commission on Dental Accreditation of the American Dental Association. (b) The applicant submits a license from each jurisdiction in which the applicant is or has ever been licensed stating that no disciplinary action is pending against the applicant or the license, and detailing all discipline, if any, which has ever been imposed against the applicant or the license. (c) The applicant has not failed the central regional dental testing service clinical and laboratory demonstration examination, or any other dental hygiene licensing examination, within the previous 3 years. (d) The applicant has successfully completed a clinical and laboratory demonstration examination on a human subject which, in the board’s judgment, is substantially equivalent to the clinical and laboratory demonstration examination administered by the central regional dental testing service. (e) The applicant has successfully completed a jurisprudence examination on the provisions of Wisconsin statutes and administrative rules relating to dentistry and dental hygiene. (f) The applicant has been engaged in the active practice of dental hygiene, as defined in s. DE 1.02 (1), in a jurisdiction in which the applicant has a current license in good standing. (g) The applicant possesses a current certificate of proficiency in cardiopulmonary resuscitation from a course provider approved by the Wisconsin department of health services. (h) The applicant has disclosed all discipline which has ever been taken against the applicant in any jurisdiction shown in reports from the national practitioner data bank and the American Association of Dental Boards. (i) The applicant has presented satisfactory responses during any personal interview with the board which may be required to resolve conflicts between the licensing standards and the applicant’s application.

History: Cr. Register, April, 1999, No. 520, eff. 5-1-99. DE 2.08 Claim of examination error. (1) An applicant wishing to claim an error on an examination administered by the board must file a written request for board review in the board office within 30 days after the date the examination was reviewed. The request shall include all of the following: (a) The applicant’s name and address. (b) The type of license applied for. (c) A description of the perceived error, including reference text citations or other supporting evidence for the applicant’s claim. (2) The request shall be reviewed by the board in consultation with a subject matter expert. The applicant shall be notified in writing of the board’s decision. Note: The board office is located at 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708. History: Cr. Register, April, 1999, No. 520, eff. 5-1-99.

History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; renum. (1) (c) and (d), 2014 WDA Sourcebook

Wisconsin Administrative Rules DE 2.09 Failure and reexamination An applicant who fails to achieve a passing grade on the board-approved examination in clinical and laboratory demonstrations may apply for reexamination on forms provided by the board and shall pay the appropriate fee for each reexamination as required in s. 440.05, Stats. If the applicant fails to achieve a passing grade on any part of the second reexamination, the applicant may not be admitted to any further examination until the applicant reapplies for licensure and presents evidence satisfactory to the board of further professional training or education as the board may prescribe following its evaluation of the applicant’s specific case. History: Cr. Register, June, 2001, No. 546, eff. 7-1-01. Chapter DE 3 PRACTICE OF DENTAL HYGIENE Note: Chapter DE 3 as it existed on February 28, 1982 was repealed and a new chapter DE 3 was created effective March 1, 1982. DE 3.01 Supervision A dental hygienist shall practice under the supervision of a licensed dentist in a dental facility or a facility specified in s. 447.08 (4), Stats., if applicable.

Wisconsin Administrative Rules

History: Cr. Register, February, 1982, No. 314, eff. 3-1-82. DE 3.02 Practice of dental hygiene defined (1) Those practices a dental hygienist may perform while a dentist is present in the dental facility include: (a) Performing complete prophylaxis which may include: 1. Removing calcareous deposits, accretions and stains from the surface of teeth; 2. Performing deep periodontal scaling, including root planing; 3. Polishing natural and restored tooth surfaces. (b) Placing temporary restorations in teeth in emergency situations. (c) Placing in an oral cavity: 1. Rubber dams; and 2. Periodontal surgical dressings; and 3. Sutures. (e) Removing excess cement from teeth, inlays, crowns, bridges and fixed orthodontic appliances. (2) Those practices a dental hygienist may perform whether or not a dentist is present in the dental facility include: (a) Preparing specimens for dietary or salivary analysis; (b) Taking impressions for and fabricating study casts and opposing casts; (c) Making and processing dental radiograph exposures; (d) Conducting a preliminary examination of the oral cavity and surrounding structures which may include preparing case histories and recording clinical findings for the dentist to review; (e) Providing prevention measures, including application of fluorides and other topical agents approved by the American Dental Association for the prevention of oral disease. (3) A dental hygienist shall report clinical findings made in the practice of dental hygiene to the supervising dentist. History: Cr. Register, February, 1982, No. 314, eff. 3-1-82. DE 3.03 Prohibited practices A dental hygienist may not: (1) Administer or prescribe, either narcotic or analgesics or systemic-affecting nonnarcotic drugs, or anesthetics. (2) Place or adjust dental appliances. (3) Diagnose any condition of the hard or soft tissues of the oral cavity or prescribe treatment to modify normal or pathological conditions of the tissues. (4) Place and carve restorations, except as specified in s. DE 3.02 (1)(b). History: Cr. Register, February, 1982, No. 314, eff. 3-1-82. DE 3.04 Oral systemic premedications and subgingival sustained release chemotherapeutic agents (1) “Oral systemic premedications” means antibiotics that are administered to patients prior to providing dental or dental hygiene services in order to mitigate against the risk of patients developing a bacterial infection. A dentist may delegate to a dental hygienist the administration of any oral systemic prophylactic antibiotic premedications.

2014 WDA Sourcebook

(2) “Subgingival sustained release chemotherapeutic agents” means medications that are applied under the gum tissue in periodontal pockets to treat periodontal, or gum, disease. (3) A dentist may delegate to a dental hygienist the administration of oral systemic premedications and subgingival sustained release chemotherapeutic agents to patients only if all of the following conditions are met: (a) The administration is performed pursuant to a treatment plan for the patient approved by a dentist. (b) The dentist remains on the premises in which the administration is performed and is available to the patient throughout the completion of the appointment. History: To be finalized late 1999 or early 2000. Chapter DE 4 EDUCATIONAL PROGRAMS MEETING LICENSING AND CERTIFICATION REQUIREMENTS Note: Chapter DE 4 as it existed on February 28, 1982 was repealed and a new chapter DE 4 was created effective March 1, 1982. Chapter DE 4 was repealed in October 2009. Chapter DE 5 STANDARDS OF CONDUCT Note: Chapter DE 5 as it existed on February 28, 1982, was repealed and a new chapter DE 5 was created effective March 1, 1982. DE 5.01 Authority The rules in this chapter are adopted pursuant to ss. 15.08 (5), 227.11 and 447.07 (3), Stats. History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; correction made under s. 13.93 (2m) (b) 7., Stats., Register, March, 1988, No.387. DE 5.02 Unprofessional conduct Unprofessional conduct by a dentist or dental hygienist includes: (1) Engaging in any practice which constitutes a substantial danger to the health, welfare or safety of a patient or the public. (2) Practicing or attempting to practice when unable to do so with reasonable skill and safety to patients. (3) Practicing or attempting to practice beyond the scope of any license or certificate. (4) Practicing or attempting to practice while the ability to perform services is impaired by physical, mental or emotional disorder, drugs or alcohol. (5) Practicing in a manner which substantially departs from the standard of care ordinarily exercised by a dentist or dental hygienist which harms or could have harmed a patient. (6) Administering, dispensing, prescribing, supplying or obtaining controlled substances as defined in s. 961.01 (4), Stats., other than in the course of legitimate practice, or as otherwise prohibited by law. (7) Intentionally falsifying patient records. (8) Obtaining or attempting to obtain any compensation by fraud. (9) Impersonating another dentist or dental hygienist. (10) Exercising undue influence on or taking unfair advantage of a patient. (11) Participating in rebate or fee-splitting arrangements with health care practitioners, unless the arrangements are disclosed to the patient. (12) Advertising in a manner which is false, deceptive or misleading. (13) Refusing to render services to a person because of race, color, sex or religion. (14) Having a license, certificate, permit, or registration granted by another state to practice as a dentist or dental hygienist limited, suspended or revoked, or subject to any other disciplinary action. (15) Violating any law or being convicted of a crime the circumstances of which substantially relate to the practice of a dentist or dental hygienist. (16) Violating any provision of ch. 447, Stats., or any valid rule of the board. (17) Violating any provision of any order of the board. (18) Failing to maintain records and inventories as required by the United States department of justice drug enforcement administration, and under ch. 961, Stats, and s. Phar 8.02, Wis. Adm. Code. (19) Violating, or aiding or abetting the violation of any law substantially related to the practice of dentistry or dental hygiene. (20) Aiding or abetting or permitting unlicensed persons in the practice of dentistry, as defined in s. 447.01 (8), Stats. (21) Aiding or abetting or permitting unlicensed persons in the practice of dental hygiene, as defined in s. 447.01 (3), Stats.

Wisconsin Administrative Rules (22) Obtaining, prescribing, dispensing, administering or supplying a controlled substance designated as a schedule II, III or IV stimulant in s. 961.16 (5), 961.18 (2m) or 961.20(2m), Stats., unless the dentist has submitted, and the board has approved, a written protocol for use of a schedule II, III or IV stimulant for the purpose of clinical research, prior to the time the research is conducted. (23) Failing to hold a current certificate in cardiopulmonary resuscitation unless the licensee has obtained a waiver from the board based on a medical evaluation documenting physical inability to comply. A waiver shall be issued by the board only if it is satisfied that another person with current certification in CPR is immediately available to the licensee when patients are present. (24) After a request by the board, failing to cooperate in a timely manner with the board’s investigation of complaints filed against the applicant or licensee. There is a rebuttable presumption that a license or applicant who takes longer than 30 days to respond to a request of the board has not acted in a timely manner under this subsection. (25) Practicing under an expired certificate of registration. History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; cr. (23), Register, August, 1984, No. 344, eff. 9-1-84; cr. (24) and (25). Register, March, 1988. No. 387, eff. 4-1-88; cr. (26), Register, December, 1989, No. 408, eff. 1-1-90; am. (18), Register, June, 1996, No. 486, eff. 7-1-96.

History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; cr. (2), Register, May, 1984, No. 341, eff. 6-1-84; r. (1), renum. (2), Register, April, 1986,. No. 364, eff. 5-1-86. Chapter DE 6 UNPROFESSIONAL ADVERTISING DE 6.01 Authority. The rules in this chapter are adopted pursuant to authority in s. 447.07 (3) (o), Stats. History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; am., Register, April, 1999, No. 520, eff. 5-1-99. DE 6.02 Unprofessional advertising. The following, without limitation because of enumeration, constitute unprofessional advertising: (1) Publishing or communicating statements or claims in any media which are false, fraudulent or deceptive. (2) Compensating or giving anything of value to media representatives in anticipation of or in return for professional publicity, unless the payment or receipt of an object of value is disclosed to the public. (3) Refusing to honor payment in the amount of an advertised price for a service during the period of time stated in the advertisement. (4) Including in an advertisement: (a) A patient’s identity or any identifiable fact, datum or information, without the patient’s permission, (b) A name of a dentist who has not been associated with the advertising dentist for the past year or longer, (c) Notice of a practice as a specialist in a dental specialty unless the dentist has successfully completed a post-doctoral educational training program approved by the Commission on Dental Accreditation of the American Dental Association in a specialty recognized by the American Dental Association. Advertising as a specialist in a nonAmerican Dental Association-recognized specialty is prohibited. History: Cr. Register, February, 1982, No. 314, eff. 3-1-82; r. (3), (4), (6), (7) (a) to (d) and (g), renum. (5), (7) (intro.), (e), (f) and (h) to be (3), (4) (intro.), (a), (b) and (c) and am. (4) (a) to (c), Register, April, 1986, No. 364, eff. 5-1-86; CR 02-138: am. (4) (c), Register November 2003 No. 575, eff. 12-1-03; CR 11-035: am. (4) (c) Register July 2012 No. 679, eff. 8-1-12. CHAPTER DE 7 CERTIFICATION OF DENTAL HYGIENISTS TO ADMINISTER LOCAL ANESTHESIA DE 7.01 Authority. The rules in this chapter are adopted pursuant to ss. 15.08 (5) (b), 227.11 (2) and 447.02 (2) (e), Stats. History: Cr. Register, October, 1999, No. 526, eff. 11-1-99.

DE 7.03 Qualifications for certification of licensed dental hygienists to administer local anesthesia. An applicant for certification to administer local anesthesia shall be granted a certificate by the board if the applicant complies with all of the following: (1) Has a current license to practice as a dental hygienist in this state. (2) Provide evidence of current qualification in cardiopulmonary resuscitation from a course provider approved by the Wisconsin department of health services. (3) Has completed the educational requirements of s. DE 7.05. (4) Has submitted the information required in the application under s. DE 7.04. History: Cr. Register, October, 1999, No. 526, eff. 11-1-99; CR 11-035: am. (2) Register July 2012 No. 679, eff. 8-1-12. DE 7.04 Application procedure. An applicant for a certificate to administer local anesthesia shall file a completed application on a form provided by the board. The application shall include all of the following: (1) The dental hygienist license number in this state and the signature of the applicant. (2) Evidence of current qualification in cardiopulmonary resuscitation from either the American heart association or the American red cross. (3) Evidence of successful completion of a didactic and clinical program sponsored by an accredited dental or dental hygiene program, resulting in the dental hygienist becoming competent to administer local anesthesia under the delegation and supervision of a dentist, the curriculum of which meets or exceeds the basic course requirements set forth in s. DE 7.05. For those dental hygienists who are employed and taking a local anesthesia program as continuing education outside of the initial accredited dental hygiene program, the administration of local anesthesia on a non-classmate may be performed at the place where the dental hygienist is employed. In those instances the application: (a) Shall contain a statement from the employing dentist that he or she supervised and verifies the successful completion of an inferior alveolar injection on a patient who was informed of the situation and granted his or her consent to the dentist, and that the dentist assumed liability for the injection performed on the patient. (b) Shall indicate that the inferior alveolar injection was completed within 6 weeks from the time that the licensed dental hygienist completed the coursework; or, if licensed by endorsement of a dental hygienist license from another state, within 6 weeks of becoming licensed as a dental hygienist in this state. Note: Applications are available upon request to the board office at 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708.

Wisconsin Administrative Rules

DE 5.03 Prohibited practice. It is a prohibited practice and shall be considered a violation of s. 447.07 (3) (k) Stats., if a dentist abrogates the copayment provisions of a contract by agreeing to forgive any or all of the patient’s obligation for payment under the contract. In this paragraph, “copayment provisions” mean any terms within a contract with a third party whereby the patient remains financially obligated to the dentist for payment.

DE 7.02 Definitions. As used in this chapter “accredited” has the meaning under s. 447.01 (1), Stats. History: Cr. Register, October, 1999, No. 526, eff. 11-1-99.

History: Cr. Register, October, 1999, No. 526, eff. 11-1-99. DE 7.05 Educational requirements. The following educational requirements are necessary for the board to approve and grant certification to a licensed dental hygienist in the administration of local anesthesia: (1) The course in the administration of local anesthesia shall be provided by an accredited dental or dental hygiene school. (2) To participate in a course in the administration of local anesthesia, a person shall do all of the following: (a) Show evidence of current qualification in cardiopulmonary resuscitation from a course provider approved by the Wisconsin department of health services. (b) Provide proof of possessing a license to practice as a dental hygienist in this state, or having graduated from an accredited dental hygiene program, or of being enrolled in an accredited dental hygiene program. (3) The local anesthesia course shall have the following components and provide a minimum of 21 hours of instruction: (a) Didactic instruction. Minimum of 10 hours, including but not limited to the following topics: 1. Provide proof of possessing a license to practice as a dental hygienist in this state, or having graduated from an accredited dental hygiene program, or of being enrolled in an accredited dental hygiene program. 2. Basic pharmacology and drug interactions. 3. Chemistry, pharmacology and clinical properties of local anesthesia, vasoconstrictors, and topical anesthesia. 2014 WDA Sourcebook

Wisconsin Administrative Rules

Wisconsin Administrative Rules 4. Anatomical considerations for the administration of anesthesia. 5. Patient assessment for the administration of anesthesia. 6. Selection and preparation of armamentarium. 7. Recognition, management and emergency response to local complications. 8. Recognition, management and emergency response to systemic complications. 9. Ethical and legal considerations. 10. Techniques for regional anesthesia. (b) Experience in the clinical administration of local anesthesia. Minimum of 11 hours in the following techniques: 1. Maxillary. a. Posterior superior alveolar. b. Middle superior alveolar. c. Anterior superior alveolar. d. Greater/lesser palatine. e. Nasopalatine. f. Supraperiosteal (infiltration) injection. 2. Mandibular. a. Inferior alveolar/lingual. b. Mental/incisive nerve block. c. Buccal nerve. d. Periodontal ligament injection. e. Intraseptal injection. (c) Students performing injections as part of the clinical coursework shall successfully perform all local anesthesia injections on their classmates as well as perform at least one successful inferior alveolar injection on a non-classmate patient. For those licensed dental hygienists who are completing this course in the continuing education environment, the injection on a non-classmate patient may be performed in the office where the dental hygienist is employed, as long as the employer-dentist agrees to supervise and submit verification of the successful completion of the injection. (d) A dentist licensed under ch. 447, Stats., shall be present in the facility and available to both the patients and to the students of the class. History: Cr. Register, October, 1999, No. 526, eff. 11-1-99; CR 11-035: am. (2) (a) Register July 2012 No. 679, eff. 8-1-12. DE 7.06 Dentist responsibility for the administration of local anesthetic. The dentist is ultimately responsible for all decisions regarding the administration of local anesthetic, particularly in determining the pharmacological and physiological considerations of each individual treatment plan. History: Cr. Register, October, 1999, No. 526, eff. 11-1-99. Chapter DE 9 LABORATORIES AND WORK AUTHORIZATIONS Note: Chapter DE 6 as it existed on April 30, 1972, was repealed and a new chapter DE 6 was created effective May 1, 1972. DE 9.01 Laboratories; definition. The term “dental laboratory” means any dental workroom directly or indirectly engaged in the construction, repair or alteration of appliances to be used as substitutes for or as a part of natural teeth or jaws or associated structures, or for the correction of malocclusions or deformities. History: Cr. Register, April, 1972, No. 196, eff. 5-1-72; renum. from DE 6.01 and am., Register, February, 1982, No. 314, eff. 3-1-82. DE 9.02 Work authorizations. Written work authorization shall be on a form approved by the board. (1) Each work authorization or a carbon copy thereof shall be retained and filed by the issuing dentist and by the dental laboratory for a period of at least 3 years from the date of issuance. The filed work authorization or carbon copy thereof shall be available for inspection by the board or its representatives during such period. (2) No dental laboratory shall have in its possession any prosthetic dentures, bridges, orthodontic or other appliances or structures to be used as substitutes for or as a part of natural teeth or jaws or associated structures, or for the correction of malocclusions or deformities, either completed or being fabricated, without having in its possession a written, signed work authorization therefore. (3) No dental laboratory shall advertise that it provides any service directly to the public. (4) The board, its agents or employees may inspect dental laboratories’ records of

2014 WDA Sourcebook

work authorization. Any dental laboratory which violates any provisions of this act, or refuses to allow the board, its agents or employees to inspect the work authorization records is subject to such penalties as provided by law. History: Cr. Register, April, 1972, No. 196, eff. 5-1-72; renum. from DE 6.02 and am., Register, February, 1982, No. 314, eff. 3-1-82. Chapter DE 11 ANESTHESIA DE 11.01 Authority and purpose. The rules in this chapter are adopted under authority in ss. 15.08 (5) (b), 227.11 (2) (a) and 447.02 (2) (b), Stats., for the purpose of defining standards for the administration of anesthesia by dentists. The standards specified in this chapter shall apply equally to general anesthesia and sedation, regardless of the route of administration. History: Cr. Register, August, 1985, No. 356, eff. 9−1−85; am. Register, October, 1988, No. 394, eff. 11−1−88; am. Register, August, 1991, No. 428, eff. 9−1−91. DE 11.02 Definitions. In this chapter, (1) “Analgesia” means the diminution or elimination of pain in a conscious patient. (1m) “Anxiolysis” means the use of medication to relieve anxiety before or during a dental procedure which produces a minimally depressed level of consciousness, during which the patient’s eyes are open and the patient retains the ability to maintain an airway independently and to respond appropriately to physical and verbal command. (2) “Conscious sedation” means a depressed level of consciousness during which the patient mimics physiological sleep, has vitals that are not different from that of sleep, has his or her eyes closed most of the time while still retaining the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command, produced by a pharmacologic or non−pharmacologic method, or a combination of pharmacologic and non−pharmacologic methods. (3) “Deep sedation” means a controlled state of depressed consciousness, accompanied by partial loss of protective reflexes, including the ability to independently and continuously maintain an airway and to respond purposefully to verbal command, produced by a pharmacologic or non−pharmacologic method, or a combination of pharmacologic and non−pharmacologic methods. (4) “General anesthesia” means a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including the ability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or non−pharmacologic method, or a combination of pharmacologic and non−pharmacologic methods. (5) “Nitrous oxide inhalation” means analgesia by administration of a combination of nitrous oxide and oxygen in a patient. (6) “Operative supervision” means the dentist is in the operatory performing procedures with the aid of qualified staff. (7) “Qualified staff” means a person is certified in the administration of basic life support in compliance with the standards set forth by the American Heart Association, the American Red Cross, or other organization approved by the board, and has training in how to monitor vital signs, and how to use a pulse oximeter, blood pressure cuff, and a precordial or a pretracheal stethoscope. If the dentist is administering deep sedation and general anesthesia under s. DE 11.07, a person shall also be trained in how to use an EKG. (8) “Routes of administration” include the following: (a) “Enteral” means administration by which the agent is absorbed through the gastrointestinal tract or through the oral, rectal or nasal mucosa. (b) “Inhalation” means administration by which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed. (c) “Parenteral” means administration by which the drug bypasses the gastrointestinal tract through either intramuscular (IM), intravenous (IV), intranasal (IN), submucosal (SM), subcutaneous (SC), or intraocular (IO) methods. (d) “Transdermal or transmucosal” means administration by which the drug is administered by patch or iontophoresis. (9) “Time−oriented anesthesia record” means documentation at appropriate intervals of drugs, doses and physiologic data obtained during patient monitoring. History: Cr. Register, August, 1985, No. 356, eff. 9−1−85; r. and recr. Register, October, 1988, No. 394, eff. 11−1−88; r. (4), renum. (1) to (3) to be (2) to

Wisconsin Administrative Rules (4) and am., cr. (1) and (5), Register, August, 1991, No. 428, eff. 9−1−91; CR 04−095: am. (1) to (4), cr. (1m) and (6) to (10), r. (5) Register August 2006 No. 608, eff. 1−1−07. DE 11.03 Requirements for nitrous oxide inhalation. (1) A dentist may use nitrous oxide inhalation on an outpatient basis for dental patients provided that he or she has adequate equipment with failsafe features and a 25% minimum oxygen flow. (2) A dentist utilizing nitrous oxide inhalation shall be trained and certified in administering basic life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association, the American Red Cross, or other organization approved by the board. History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07. DE 11.04 Requirements for anxiolysis. A dentist utilizing anxiolysis shall be trained and certified in administering basic life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association, the American Red Cross, or any other organization approved by the board. History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07.

History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07. DE 11.06 Requirements for conscious sedation–parenteral. (1) Beginning on January 1, 2007, no dentist may administer conscious sedation via a parenteral route without having first obtained a class 2 permit from the board, unless a dentist has been granted a permit under s. DE 11.07. A class 2 permit enables a dentist to utilize conscious sedation−enteral, and conscious sedation−parenteral. The board shall grant a class 2 permit to administer conscious sedation−parenterally to a dentist who does all of the following: (a) Provides proof of one of the following: 1. A board approved training course which includes: a. A minimum of 60 hours of didactic instruction which addresses the physical evaluation of patients, IV sedation, and emergency management. b. Twenty clinical cases of managing parenteral routes of administration. 2. Graduate level training approved by the board that, at a minimum, includes the requirements as set forth in subd. 1. 3. The utilization of conscious sedation administered parenterally on an outpatient basis for 5 years preceding January 1, 2007, by a dentist licensed under this chapter.

History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07. DE 11.07 Requirements for deep sedation and general anesthesia. (1) Beginning on January 1, 2007, no dentist may administer deep sedation or general anesthesia without having first obtained a class 3 permit from the board. A class 3 permit enables a dentist to utilize conscious sedation−enteral, conscious sedation−parenteral, deep sedation, and general anesthesia. The board shall grant a class 3 permit to administer deep sedation or general anesthesia to a dentist who does all of the following: (a) Provides proof of one of the following: 1. Successful completion of a board approved postdoctoral training program in the administration of deep sedation and general anesthesia. 2. Successful completion of a postdoctoral training program in anesthesiology that is approved by the Accreditation Council for Graduate Medical Education. 3. Successful completion of a minimum of one year advanced clinical training in anesthesiology provided it meets the objectives set forth in part 2 of the American Dental Association’s “Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry.” 4. Has been a licensed dentist under this chapter who has been utilizing general anesthesia for 5 years prior to January 1, 2007. (b) Provides proof of certification in advanced cardiac life support. If the dentist is a pediatric specialist, the dentist is allowed to substitute certification in pediatric advanced life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association, or any other organization approved by the board. (2) Any dentist who administers deep sedation or general anesthesia shall have qualified staff present throughout the dental procedure. (3) Nothing in this section may be construed to prevent a dentist from employing or working in conjunction with a certified registered nurse anesthetist, or with a licensed physician or dentist who is a member of the anesthesiology staff of an accredited hospital, provided that the anesthesia personnel must remain on the premises of the dental facility until the patient under general anesthesia or deep sedation regains consciousness.

Wisconsin Administrative Rules

DE 11.05 Requirements for conscious sedation–enteral. (1) Beginning on January 1, 2007, no dentist may administer conscious sedation via an enteral route without having first obtained a class one permit from the board, unless a dentist has been granted a permit under s. DE 11.06 or 11.07. A class one permit enables a dentist to utilize conscious sedation enterally. The board shall grant a class one permit to administer conscious sedation enterally to a dentist who does all of the following: (a) Provides proof of one of the following: 1. A board approved training course which includes: a. Eighteen hours of didactic instruction which addresses physical evaluation of patients, conscious sedation−enteral, emergency management, and conforms to the principles in part one or part 3 of the American Dental Association’s “Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry.” b. Twenty clinical cases utilizing an enteral route of administration to achieve conscious sedation, which may include group observation. 2. Graduate level training approved by the board that, at a minimum, includes the requirements as set forth in subd. 1. a. and b. (b) Provides proof of certification in basic cardiac life support for the health care provider and a board approved training program in airway management or a course in advanced cardiac life support. If the dentist is sedating patients age 14 or younger, the dentist shall provide proof of certification in pediatric advanced life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association, the American Red Cross, or any other organization approved by the board. (2) Any dentist who utilizes an enteral route of administration to achieve conscious sedation shall have qualified staff present throughout the dental procedure.

(b) Provides proof of certification in advanced cardiac life support. If the dentist is a pediatric specialist, the dentist is allowed to substitute certification in pediatric advanced life support. This certification shall be renewed in compliance with the standards set forth by the American Heart Association, or any other organization approved by the board. (2) Any dentist who utilizes a parenteral route of administration to achieve conscious sedation shall have qualified staff present throughout the dental procedure.

History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07. DE 11.08 Office facilities and equipment. (1) A dental office shall have all of the following if a dentist is administering conscious sedation−enteral, conscious sedation−parenteral, deep sedation, and general anesthesia: (a) An operating room containing all of the following: 1. Oxygen and supplemental gas−delivery system capable of delivering positive pressure oxygen ventilation. 2. Suction and backup system. 3. Auxiliary lighting system. 4. Gas storage facilities. 5. An operating chair capable of withstanding cardiopulmonary resuscitation or a back board. 6. Emergency equipment including a defibrillator, cardiopulmonary pocket mask, and appropriate emergency medications. 7. Monitoring equipment including a pulse oximeter, blood pressure cuff, and precordial or pretracheal stethoscope. 8. An EKG if administering deep sedation or general anesthesia. (b) A recovery room containing all of the following: 1. Oxygen and supplemental gas−delivery system capable of delivering positive pressure oxygen ventilation. 2. Suction and backup system. 3. Auxiliary lighting system. 4. Wheelchair. 5. An operating chair capable of withstanding cardiopulmonary resuscitation or a back board. 2014 WDA Sourcebook

Wisconsin Administrative Rules 6. Emergency equipment including a defibrillator, cardiopulmonary pocket mask, and appropriate emergency medications. (2) Nothing in this section shall be construed to prevent an operating room from also being used as a recovery room, nor shall it be construed to prevent the sharing of equipment between an operating room and a recovery room, provided all the required equipment is in the room being used.

Wisconsin Administrative Rules

History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07. DE 11.09 Standards of care. (1) Before the administration of any type of sedation a complete written medical history shall be obtained from each patient. The medical history shall identify any medications a patient is taking and any allergies to medication a patient has. (2) The recording of a time−oriented anesthesia record including appropriate vital signs, blood pressure, pulse, and oxygen saturation q 5 minutes, is required for conscious sedation−enteral, conscious sedation−parenteral, deep sedation, and general anesthesia. (3) During the anesthesia period for conscious sedation−enteral, conscious sedation−parenteral, deep sedation, or general anesthesia, the oxygenation, ventilation, and circulation of the patient shall be continually evaluated, and any medications that are administered shall be documented in writing, including the dosages, time intervals, and the route of administration. (4) A patient shall be continually observed during the anesthesia period for conscious sedation−enteral, conscious sedation−parenteral, deep sedation, and general anesthesia either by the treating dentist or by qualified staff. No permit holder shall have more than one person in conscious sedation−enteral, conscious sedation− parenteral, deep sedation, or general anesthesia at one time, notwithstanding patients in recovery. (5) Operative supervision is required for deep sedation and general anesthesia. (6) Qualified staff shall continuously monitor post−treatment patients before final evaluation and discharge by the dentist. Written post−operative instructions shall be given to each patient or to a responsible adult who accompanies the patient for those individuals having undergone conscious sedation−enteral, conscious sedation−parenteral, deep sedation, or general anesthesia. Documentation of the post−operative instructions shall be noted in the patient’s chart. (8) Any dentist whose patient lapses into conscious sedation− enteral from anxiolysis shall meet the requirements found in s. DE 11.05 and shall follow any applicable requirements in s. DE 11.09. (9) Unless a dentist holds a class 3 permit, he or she shall not administer any drug that has a narrow margin for maintaining consciousness including, but not limited to, ultra−short acting barbiturates, propofol, ketamine, or any other similarly acting drugs. (10) Dentists shall maintain verifiable records of the successful completion of any and all training of staff. History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07. DE 11.10 Reporting of adverse occurrences related to anesthesia administration. Dentists shall submit a report within 30 days to the board of any mortality or other incident which results in temporary or permanent physical or mental injury requiring hospitalization of a patient during, or as a result of, anesthesia administration under this chapter. The report shall be on a form approved by the board and shall include, at the minimum, responses to all of the following: (1) A description of the dental procedures. (2) The names of all participants in the dental procedure and any witnesses to the adverse occurrence. (3) A description of the preoperative physical condition of the patient. (4) A list of drugs and dosage administered before and during the dental procedures. (5) A detailed description of the techniques utilized in the administration of all drugs used during the dental procedure. (6) A description of the adverse occurrence, including the symptoms of any complications, any treatment given to the patient, and any patient response to the treatment. (7) A description of the patient’s condition upon termination of any dental procedures undertaken. Note: Forms are available at the office of the Dentistry Examining Board located at 1400 East Washington Avenue, P.O. Box 8935, Madison, WI 53708.

2014 WDA Sourcebook

Note: Section DE 11.09 (7), dealing with titration, has been removed from the rule in compliance with statutory restraints based on the objections by the Senate Committee on Health and the Joint Committee for Review of Administrative Rules. The Wisconsin Dentistry Examining Board intends to promulgate s. DE 11.09 (7) upon resolution of those objections. History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07. Chapter DE 12 DELEGATION OF FUNCTIONS TO UNLICENSED PERSONS DE 12.01 Nondelegated functions. A dentist may not delegate any dental procedure of any description to an unlicensed person if the procedure to be delegated: (1) Is of a character which may cause damage to the patient’s teeth or oral cavity which cannot be remedied without professional intervention. (2) Is of a character which may cause adverse or unintended general systemic reaction. (3) Is intended interpreted, or represented to be preliminary assessments, dental hygiene treatment planning, oral screenings, oral prophylaxes or any portion of an oral prophylaxis other than supragingival rubber cup and air polishing after calculus is removed if necessary, scaling or root planing, or dental sealants. History: Cr. Register, August, 1991, No. 428, eff. 9-1-91; am. (3), Register, January, 1996, No. 481, eff. 2-1-96. DE 12.02 Training. A dentist who delegates any dental procedure or function to an unlicensed person must first train or verify the training of the person in the performance of the procedure or function, and must maintain verifiable records on forms approved by the board of the successful completion of the training by the unlicensed person. History: Cr. Register, August, 1991, No. 428, eff. 9-1-91. DE 12.03 Reporting Violations. A dentist or dental hygienist who becomes aware that any dentist is improperly delegating the performance of any dental procedure or function to an unlicensed person, or to a person who is performing the delegated procedure or function in a manner which is less than minimally competent, shall report the circumstances to the board. Failure to report the circumstances of improper delegation by a dentist constitutes aiding and abetting the violation of a law substantially related to the practice of dentistry or dental hygiene, and is a violation of s. DE 5.02 (20). History: Cr. Register, August, 1991, No. 428, eff. 9-1-91. DE 12.04 Allowable delegation. An unlicensed person may remove plaque and materia alba with a mechanical device only if the delegation of the function complies with ss. DE 12.01 and 12.02. History: Cr. Register, August, 1991, No. 428, eff. 9-1-91. DE 13.01 Authority. The rules in this chapter are adopted by the dentistry examining board under the authority of ss. 227.11 (2), 447.02 (1) (f), 447.055 and 447.056, Stats. History: CR 11-033: cr. Register July 2012 No. 679, eff. 8-1-12. DE 13.02 Definitions. In this chapter: (1) “Accredited” means accredited by the American Dental Association Commission on Dental Accreditation or its successor agency. (2) “Credit hour” means 60 minutes, of which at least 50 minutes are instruction attended by the student. (3) “Professional organization” means an organization that seeks to further the dental, dental hygiene, or medical professions, the interests of licensees engaged in those professions, and the public interests. “Professional organization” includes a study group, as defined in sub. (4). (4) “Study group” means a group of 2 or more dentists or dental hygienists who discuss continuing education topics relating to the practice of dentistry or medicine, or the clinical practice of dental hygiene, and that satisfies all of the following: (a) Has been in existence as a group for at least one year. (b) Meets face-to-face at least once each year to discuss issues. (c) Has adopted by-laws governing the operation of the group.

Wisconsin Administrative Rules History: CR 11-033: cr. Register July 2012 No. 679, eff. 8-1-12.

History: CR 11-033: cr. Register July 2012 No. 679, eff. 8-1-12. DE 13.05â&#x20AC;&#x192; Criteria for acceptance of continuing education programs. (1) Dentists. The board accepts continuing education programs for dentists that satisfy the following criteria: (a) The subject matter of the continuing education program relates to the practice of dentistry or the practice of medicine. (b) The continuing education program is one of the following: 1. Sponsored or recognized by a local, state, regional, national, or international dental or medical professional organization. 2. A college level course that is offered by a postsecondary institution accredited by the American Dental Association Commission on Dental Accreditation or a successor agency, or by another recognized accrediting body. 3. A study group as specified in s. DE 13.02 (4). (2) Dental Hygienists. The board accepts continuing education programs for dental hygienists that satisfy the following criteria: (a) The subject matter of the continuing education program relates to the clinical practice of dental hygiene or the practice of medicine. (b) The continuing education program is one of the following: 1. Sponsored or recognized by a local, state, regional, national, or international dental, dental hygiene, dental assisting, or medical related professional organization. 2. A study group as specified in s. DE 13.02 (4).

Wisconsin Administrative Rules

DE 13.03â&#x20AC;&#x192; Continuing education requirements for dentists. (1) Completion of continuing education credit hours. Except as provided under sub. (6), during the 2-year period immediately preceding the renewal date specified under s. 440.08 (2) (a), Stats., a dentist shall complete 30 credit hours of continuing education related to the practice of dentistry or the practice of medicine. The 30 credit hours of continuing education shall include not less than 25 credit hours of instruction in clinical dentistry or clinical medicine. (2) Credit for teaching or preparing a program. One hour of teaching or preparing a professional dental or medical program is equivalent to one credit hour of continuing education. A licensee who teaches or prepares a professional dental or medical program may obtain credit for the program only once during a biennium. Not more than 4 of the 30 hours may be from teaching. (3) Credit for college level courses. One credit hour of a college level course is equivalent to 6 credit hours of continuing education. A licensee may substitute credit hours of college level courses related to the practice of dentistry or medicine for the required continuing education credit hours. (4) Credit for distance education. The credit hours required under sub. (1) may be satisfied by independent study, correspondence, or internet programs or courses. (5) Credit for accredited residency training program. Active enrollment in an accredited postdoctoral dental residency training program for at least 12 months of the current licensure cycle will be accepted as meeting the required 30 credit hours of continuing education. (6) Exemption for new licensees. Subsection (1) does not apply to an applicant for renewal of a license that expires on the first renewal date after the date on which the applicant is licensed. (7) Certification statement. At the time of each renewal, each licensee shall sign a statement certifying that, within the 2 years immediately preceding the renewal date specified under s. 440.08 (2) (a), Stats., he or she has completed the continuing education credit hours required under sub. (1). (8) Failure to complete continuing education hours. A licensee who fails to complete the continuing education requirements by the renewal date specified under s. 440.08 (2) (a), Stats., shall not practice dentistry until his or her license is restored under s. DE 2.03 (5). (9) Time limits on obtaining credits. Credit hours completed before the 2-year period immediately preceding renewal of a license to practice dentistry may not be applied to fulfill the credit hours required under sub. (1). (10) Recordkeeping. Every licensee shall maintain a written record of the continuing education hours required under sub. (1) for not less than 6 years after completion of each credit. (11) Waiver of continuing education hours. The board may waive the continuing education requirements under sub. (1) if it finds that exceptional circumstances such as prolonged illness, disability, or other similar circumstances have prevented a licensee from meeting the requirements.

(6) Certification statement. At the time of each renewal, each licensee shall sign a statement certifying that within the 2 years immediately preceding the renewal date specified under s. 440.08 (2) (a), Stats., he or she has completed the continuing education credit hours required under sub. (1). (7) Failure to complete continuing education hours. A licensee who fails to meet the continuing education requirements by the renewal date specified under s. 440.08 (2) (a), Stats., shall not practice dental hygiene until his or her license is restored under s. DE 2.03 (5). (8) Time limits on obtaining credits. Credit hours completed before the 2-year period immediately preceding renewal of a license to practice dental hygiene may not be applied to fulfill the credit hours required under sub. (1). (9) Recordkeeping. Every licensee shall maintain a written record of the continuing education hours required under sub. (1) for not less than 6 years after completion of each credit. (10) Waiver of continuing education hours. The board may waive the continuing education requirements under sub. (1) if it finds that exceptional circumstances such as prolonged illness, disability, or other similar circumstances have prevented a licensee from meeting the requirements.

History: CR 11-033: cr. Register July 2012 No. 679, eff. 8-1-12.

History: CR 11-033: cr. Register July 2012 No. 679, eff. 8-1-12. DE 13.04â&#x20AC;&#x192; Continuing education requirements for dental hygienists. (1) Completion of continuing education credit hours. Except as provided in sub. (5), during the 2-year period immediately preceding the renewal date, a dental hygienist shall complete 12 credit hours of continuing education related to the clinical practice of dental hygiene or the practice of medicine. No more than 2 of the 12 credit hours may be satisfied by training related to basic life support or cardiopulmonary resuscitation. Not less than 2 of the 12 credit hours shall include training in infection control. (2) Credit for teaching or preparing a program. One hour of teaching or preparing a professional dental or medical program is equivalent to one credit hour of continuing education. A licensee who teaches or prepares a professional dental or medical program may obtain credit for the program only once during a biennium. (3) Credit for college level courses. One credit hour of a college level course is equivalent to 6 credit hours of continuing education. A licensee may substitute credit hours of college level courses related to the practice of dental hygiene or the practice of medicine for the required continuing education credit hours. (4) Credit for distance education. The credit hours required under sub. (1) may be satisfied by independent study, correspondence, or internet programs or courses. (5) Exemption for new licensees. Subsection (1) does not apply to an applicant for renewal of a license that expires on the first renewal date after the date on which the applicant is licensed. 2014 WDA Sourcebook

Here to help your practice succeed Managing a dental practice today requires so much more than dental expertise. Staying on top of coding changes, understanding new government regulations and keeping your employees happy are just a few of the other issues vying for your time. If you’re spending more time than you’d like on practice management issues, give Schenck a call. Our unique knowledge of the dental health care environment makes us an ideal resource for dentists. Our expertise includes a full range of services: • • • • •

Accounting and tax planning— business and personal Practice valuations and transitions Enhancing practice profitability Financial assessments Dental operations

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We’re here to help you achieve your financial goals, both personal and professional. Give us a call at 800-236-2246 and one of our experienced dental practice management consultants will be happy to answer your questions or schedule a no cost or obligation meeting.

X-ray Regulations

2014 radiation protection update William Balke Wisconsin DHS X-ray Supervisor william.balke@wisconsin.gov

Questions about the status of a variance should be directed to the Radiation Protection Section or one of the Wisconsin X-ray inspectors. For more information, visit www.dhs.wisconsin.gov/radiation/license/Xray/index.htm.

Annual X-ray device renewals Annual X-ray device registration renewals for 2014 dental facilities were sent out in November 2013. If you do not have a 2014 registration certificate, please contact the Radiation Protection Section (RPS) as soon as possible. We have a new database registration system and it works well, but like any new system, there is a learning curve. Any changes that occur at your site should be sent in prior to the renewal time. Wisconsin Administrative Code DHS 157 has always stated that any changes to the registration information be sent to our office within 30 days. In the past, we accepted notification of changes that occurred throughout the year as part of the renewal cycle.

Cone beam CT units Installation and use of cone beam CT units are increasing in Wisconsin. During the past three years, the current number of CBCT units in Wisconsin went from two to 31 devices. Unlike dental pantographic units, CBCT units do require a shielding plan review. This is due to the higher radiation output potential. Cephalometric devices New Cephalometric X-ray unit installations require a shielding plan as detailed in DHS 157. Inspectors have noticed that ceph units are often installed as an afterthought and safety considerations have not been entirely addressed.

The new database is more automated, and thus not as flexible. Changes not sent in prior to the renewal notice will likely result in significant delays in processing your registration. Why is this important to you? Let’s say your business insurance providers and patients’ insurance companies require you to have your permits and other documentation current. If they discover this delay/seeming lapse, it could lead to additional work for your office informing a number of business contacts of your status.

As examples, inspectors have found:

When changes to your site occur (new X-ray unit acquired, new contact person, address change or business name change), please don’t wait for renewal time; notify the Radiation Protection Section within 30 days of the change.

• The central ray is essentially being directed into the open door of the next operatory

Current registration fees for dental X-ray devices are unchanged at $50 per site plus $35 per tube. Hand-held dental units Since about 2005, hand-held dental X-ray units have been approved for sale in the United States by the U.S. Food and Drug Administration. Wisconsin Administrative Code, DHS 157.80 (9) (b) states: (b) the tube housing and the cone may not be hand-held during an exposure. Wisconsin does not recommend or endorse any manufacturer of X-ray devices; we do test devices and/or review documentation of safety testing before a unit can be used here. This office has issued a variance to DHS 157.80(9) for one hand-held dental manufacturer’s design. We also have been contacted by two other manufacturers. This office has reviewed documentation and/or tested hand-held dental units and found: • While no unit reviewed would likely cause the operator to exceed their annual Maximum Permissible Dose, some designs result in marginally higher operator exposure and purchasers should evaluate their options carefully. • Hand-held dental devices that have the variance are not to be used without the backscatter shield attached around the beam limiting cylinder (“cone”).

• The operator couldn’t see the patient while standing at the control

While Cephalometric exams are a relatively low number of exposures in most dental practices, ALARA (as low as reasonably achievable) principles can be applied without high cost or negative effect on patient flow or image quality. Inspection findings Since 2002, the RPS requires all dental offices using film imaging to regularly conduct film processor quality control testing. Since implementing inspections with the new code, our inspection results show that compliance has improved, but this is still one of our most frequent areas of noncompliance. One repeated comment we still hear is “my processor is always within the expected range.” That is precisely what you want (and what we want documented). Please remember quality control is an ongoing process. Patient care and reducing patient dose is directly related to processor quality control. A good reference for the proper use of X-rays in the dental office can be found in the September 2006 Journal of the American Dental Association. Table 2 of the article titled “The use of dental radiographs; update and recommendations” is a good guide for quality assurance. The ADA recommends that “E” speed or “F” speed film be used for all intraoral radiographs. The RPS has found that many Wisconsin offices are still using “D” speed film. Offices that use “E” speed or “F” speed films have reduced patient exposure by 20 and 40 percent, respectively.

• Operators of hand-held dental units, with the back scatter shield deployed properly, are not required to wear a lead apron during exposure.

The “graininess” that some practitioners report can be reduced or eliminated by using the proper exposure factors. If you reduce your exposure, too much “graininess” will result. Arrangements can be made with a state inspector to use a tooth phantom and make test exposures to compare image quality and dose reduction.

• We recommend that for the first year of use, hand-held X-ray device users wear personal dosimetry in the form of ring badges to document both the site and operators’ safe use of the device and to prove the device is safe to the operators’ themselves.

Offices that have a mixture of digital and film are still required to conduct the film processor quality control tests.

• Certain manufacturers have a device design, display or advertisement that indicates the backscatter disk is either optional or not included. These units, while approved for sale in the U.S., have not been approved for use here in Wisconsin. In states where devices designed without backscatter shields are being used, operators are required to wear lead aprons when making exposures.

X-ray Regulations

As always, we need the renewal form (or copy) returned with your payment so it can be applied correctly and without delay.

• A combination pan/ceph unit was installed so the ceph image receptor was next to the location of the exposure switch

Digital imaging As of June 2010, regular quality control (QC) testing for digital dental units is now mandatory. All digital units (DR or CR) have some type of quality control testing in their operator or service manuals. A dental practice using a digital X-ray imaging system may have to contact the 2014 WDA Sourcebook

X-ray Regulations service person for their device to find the procedure recommended by the manufacturer of their system, but inspectors will be looking for documentation of digital QC. The QC records can be maintained electronically. Facilities continue to convert to digital imaging. There are two types available: DR and CR. DR systems have a special receptor that goes into the patient’s mouth and the image is digitized directly through a solid state detector. This detector connects directly (wire or wireless) to a computer/digital viewing screen. The image is almost immediately available on a display. CR systems use a film-type material that looks more like a conventional film packet. The image receptor is a material that captures the image and displays it in the processing unit when stimulated by a laser. The image is digitized and available for electronic display and interpretation.

X-ray Regulations

The radiation dose required for digital imaging can be substantially less than for film imaging. DR systems require approximately 30 percent of the radiation required for “D” speed film. The RPS has inspected facilities where the dose to the patient is only 30mR vs.150mR – 200mR for film. CR requires a slightly higher dose than DR, but still less than film. CR systems are around 40-60 percent of the dose required for “D” speed film imaging. CR systems can have processing artifacts caused by physical damage to the image receptors. DR images can have artifacts, usually caused by motion of the detector unit in the patient’s mouth. Either CR or DR can be damaged if bitten down on hard by the patient. Training and dose creep continue to be concerns for RPS inspectors at digital imaging locations. RPS continues to find inconsistent training for staff on proper exposure techniques. In some cases, facilities use the same exposure values on digital imaging systems as they do for film. RPS inspectors have tooth phantoms that can demonstrate how much you can lower the does and still have a diagnostic image. The other identified issue is what medical physicists refer to as “dose creep”, which is when X-ray device operators gradually increase the exposure factor(s) for a specific exam procedure knowing they have more adjusting latitude if the image is slightly overexposed than underexposed. Both situations result in overexposure to the patient without improving image quality. In fact, high radiation doses can overwhelm the digital receptors and may actually cause data to be lost. Based on manufacturers’ literature, a typical 70 kV dental exposure for DR should be 4-8 pulses and 8-14 for CR, compared to typical 18-22 pulses for film. The code requires technique charts posted near controls for this very reason. The RPS still finds offices where operators are each using different techniques on the same machine for the same size/type patients. In some cases, this is because employees were not properly trained in the new exposure settings and the new techniques were not posted, as required. If you have rotating or part-time staff, it is critical that everyone who operates the X-ray equipment is properly trained, especially after changing imaging modalities. I-CAT dental CT systems are appearing more frequently. These CT systems have a higher scatter radiation rate than pan or intra oral systems and may need radiation shielding of the room if the workload exceeds about 350 milliAmp minutes per week of total exposure time. This is the number of minutes per patient exposure, times the X-ray tube filament current. A drawing of room design and radiation shielding need to be submitted to the RPS for review prior to the installation of the CT equipment. The operators of dental CT devices must receive documented training for this piece of equipment.

Two methods are available to determine what radiation exposure, if any, an employee is receiving: 1. Obtain personal dosimeters for each of the routinely-exposed workers in an office and wear them for 12 months. Dosimeters are never shared nor used as “area” monitors. They may be exchanged quarterly. At the end of the test period, evaluate the results; any worker who exceeds the equivalent of 500 mR in a calendar year will be required to be regularly assigned a dosimeter until their exposures fall below the 500 mR/yr level. A site using the hand-held “Nomad” (currently the only hand-held unit permitted in Wisconsin) should use collar and ring badges to demonstrate the safety/protection for their personnel. 2. Direct radiation exposure calculation. When RPS inspectors are in your office for routine inspections, they can conduct measurements at the operator positions to determine whether dosimeters will be required. Dosimeters will not be required in dental offices 99 percent of the time. The RPS has tested hundreds of offices and has found very few where dosimeters were recommended. Radiation safety policy The 2002 code changes require each office to have a radiation safety policy manual that is reviewed by each staff person who routinely uses the X-ray equipment. A customizable generic manual is available online, along with information on X-ray device registration, surveys and inspections at www.dhs.wisconsin.gov/dph_beh/BEH/X-ray/index.htm. Protective aprons The RPS receives questions regarding protective aprons for patients and staff. Protective aprons used for gonadal shielding are not required for patients in dental offices, but most patients expect them. Protective aprons for staff are required only when a staff person must be in the room with the patient during a radiograph. This may be necessary for patient stabilization or holding the digital receptor for children. Dosimeters should be worn if a staff person has to be in the room consistently. Please remember neither the patient nor the operator is permitted to hold the X-ray tube head during exposure. The person holding or assisting should not be holding the image receptor. Use a tongue depressor or clamp if the image receptor needs support. At no time should the holder be in the primary X-ray beam. The question also arises to whether protective aprons should be worn if the dental office imaging is done digitally. The use of protective aprons is still recommended.

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ciatio ental Asso D in s n o c is with the W

Personal dosimeters Proper practice in determining radiation exposure to the operators is a continuing subject for discussion. The code requires that operators receive no more than 5000 mrem (50mSv) per year. Pregnant X-ray device operators can receive no more than 500 mrem (5mSv) during the course of the pregnancy and no more than 50mrem (.5mSv) in a month. A pregnant worker must declare her pregnancy in writing to the employer to be considered pregnant. Declared pregnant workers must be provided a dosimeter that is changed each month.

2014 WDA Sourcebook

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Frequently Asked Practice and Legal Questions

Glossary

ADA – American Dental Association CDC – Centers for Disease Control and Prevention COB – Coordination of Benefits CDT – Current Dental Terminology DEB – Dentistry Examining Board DEA – Drug Enforcement Administration DHS – Department of Health Services EOB – Explanation of Benefits HIPAA – Health Insurance Portability and Accountability Act MA – Medicaid OSHA – Occupational Safety and Health Administration WAC – Wisconsin Administrative Code WDA – Wisconsin Dental Association

WHAT REGISTRATION OR DISCLOSURE REQUIREMENTS MUST BE FOLLOWED IN ORDER TO IMPOSE A SURCHARGE? Your ability to apply a surcharge is conditioned on abiding by certain registration and disclosure requirements: Register – You must register, by way of written notice, with your network and the bank or financial institution that processes your credit card payments, within 30 days prior to surcharging. The notice must identify whether you intend to impose surcharges at the brand level or the product level. Disclosure at point of entry – You must provide clear disclosure to your patients at the point of entrance to the dental office, or in an online environment on the first page that references credit card brands that you impose a surcharge on credit card transactions that is not greater than your applicable cost of acceptance. Disclosure at point of sale – You must provide clear disclosure to your patients of your surcharging practices at the point of interaction or sale with your patient in a manner that does not disparage the brand, network, issuing bank, or the payment card product being used. Such disclosure must include:

Frequently Asked Practice and Legal Questions

• Statement that you are imposing a surcharge

Table of Contents

• Amount of the surcharge

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Disclosure on receipt – You must provide clear disclosure of the dollar amount of the surcharge on the transaction receipt you provide to your patient.

Billing...................................................................................... 80 Children of divorced parents........................................................ 82 Delegation of duties................................................................... 83 Dental records........................................................................... 84 Domestic abuse......................................................................... 86 Medicaid and discounts.............................................................. 87 HIPAA...................................................................................... 90 Insurance and coordination of benefits.......................................... 92 Licensing and continuing education.............................................. 93 Employment law and human resources ....................................... 94 Amalgam recycling and dental waste ........................................... 96 OSHA and CDC guidelines..................................................................96 Malpractice............................................................................... 96 Mandatory insurance/benefit coverage......................................... 96 Patient abandonment................................................................. 97 X-rays and Exams...................................................................... 97

1. BILLING CAN I CHARGE PATIENTS WHO PAY BY CREDIT CARD A SURCHARGE? Yes, Pursuant to a 2012 court settlement between retailers, MasterCard, Visa and nine major banks, you are permitted to impose a surcharge on patients who pay by credit card. However, if patients pay by debit or prepaid card, no surcharge may be imposed. The option to impose a surcharge applies to all payment channels (e.g., in person, online, through the mail or through the phone). You are permitted to apply either a brand-level surcharge or a product-level surcharge to credit cards transactions. A brand-level surcharge is one where you charge the same percentage on all credit cards brands. A product-level surcharge is one where you impose a surcharge on a particular credit card product (e.g., Classic Card, Traditional Rewards Card, Signature Card, etc.). In both circumstances, the percentage of the surcharge is subject to a cap. The surcharge may not exceed the “merchant discount rate,” which is the fee, expressed as a percentage of the total transaction amount; you pay for transacting on a credit card brand. There is also an absolute maximum surcharge cap that is set at 4 percent. It is highly recommended that you contact each credit card brand you accept to determine the maximum surcharge you are permitted to charge.

2014 WDA Sourcebook

• Statement that the surcharge is not greater than your applicable cost of acceptance

IF I DECIDE TO APPLY A SURCHARGE, DO I HAVE TO APPLY IT TO ALL CREDIT CARD BRANDS THAT MY PRACTICE ACCEPTS? Most major credit card brands have a non-discrimination rule in the agreement between you and the credit card company. This non-discrimination rule usually requires you to treat all card brands the same, so either surcharge all or surcharge none. That said, if you intend to have a different surcharge policy depending upon the credit card brand, you should consult your legal adviser to make sure you are complying with the terms of the agreement you signed with each credit card company. MISTAKENLY THOUGHT A PATIENT’S DELINQUENT ACCOUNT WAS SENT TO COLLECTIONS. THE ACCOUNT IS SEVERAL YEARS OVERDUE AND THE PATIENT HAS NOT RECEIVED ANY STATEMENTS FROM MY OFFICE FOR YEARS. WHAT ARE MY OPTIONS? As a rule, you may attempt to collect upon a delinquent account at any time. However, there are a number of considerations that may affect what you decide to do in any particular situation. In the specific situation described: • Consider the amount involved and whether there is an ongoing relationship with the patient. If it is a small amount or if there is an otherwise acceptable relationship, the overdue amount may be written off. • If it is a larger amount and/or if there is no ongoing patient relationship, collection may be a more suitable option. In that case, you can either assign it directly to collections or send a notice (since it has been several years since the treatment) reminding the patient of the amount outstanding. If you send the notice, you might want to include language indicating you will assign it for collection if the amount is not paid within some number of days (generally 30 or 45). • If the account is more than 6 years old, it may be legally uncollectible. The provision of services in exchange for payment is treated as a contract for legal purposes and the statute of limitations for enforcement of contract rights (your right to payment) is six years; regardless if the account is still at your office or at a collection agency. As a general matter, you may wish to establish and enforce an office policy for billing and collections. Once you send a statement, it can specify that payment is required within any specified number of days (there is no legal requirement here as to how long, just so the number of days is not different from something else you may have told the patient) – 30 or 45 days are fairly normal periods. If not paid in that time, you could immediately turn the account over to collections, although a far more common practice is to send a last reminder notice saying they have only 30 more days before it goes to collections. At that point, common practice is to use a “final notice” statement saying that if payment is not received in some lesser number of days (normally 10) the account will be handed over to your contracted collection agency. After you send this final notice with collection action stated, do not send additional statements as that can be viewed as harassment beyond this point.

Frequently Asked Practice and Legal Questions You should also be aware, while there are no set time limits, the process of debt collection itself is subject to the Fair Debt Collection Practices Act. While this statute normally applies only to debt collectors, several court cases have applied it to creditors who were engaged in deceptive practices. Further, debtors have attempted to hold creditors liable for the actions of a third-party debt collector employing various common law theories (claiming that the creditor is liable for the actions of its agent, the debt collector), state consumer laws (which sometimes offer enhanced debtor protection) and negligent referral (claiming the account was negligently or improperly referred to the debt collector). As a general rule these lawsuits have been met with limited success, with only the extreme cases making any headway in court. Wisconsin has its own debt collection statute (Chapter 427 of the Wisconsin Consumer Act) which applies to both debt collectors and creditors. Consequently if you decide to handle delinquent account collections yourself, you should review and become familiar with the state law. WHAT DO DENTISTS NEED TO KNOW ABOUT HOW PATIENT BANKRUPTCIES MAY IMPACT THEIR COLLECTIONS ON UNPAID BILLS? In the United States, bankruptcy laws serve the dual purpose of providing a fresh start to individuals who cannot pay their debts and providing creditors with an orderly method to recover at least a portion of the amounts owed them. Types of bankruptcy cases

f) Usually, the court will appoint a committee of unsecured creditors (typically the larger creditors) to represent the creditors’ collective interests. 3. Chapter 13: Rehabilitation of individual debtors a) Similar to Chapter 11 business reorganizations, Chapter 13 allows an individual to submit a plan to repay at least a portion of the claims of creditors during a three-five year period. Often only a small portion of each claim can be repaid under Chapter 13 plans. b) A trustee oversees the debtor’s plan, which is funded from the future disposable income of the debtor. c) Part of the trustee’s job is to make sure as much of the claims are repaid as possible. During this time creditors cannot attempt to collect pre-bankruptcy debts from the debtor other than under the Chapter 13 plan (see automatic stay below). Automatic stay Once a debtor has filed a bankruptcy petition, an injunction takes effect immediately ( known as automatic stay). The automatic stay stops collection efforts of creditors whose claims arose prior to the beginning of the bankruptcy proceeding. This means that creditors will not be able to commence a lawsuit against the debtor, enforce a judgment, repossess property of the bankruptcy estate, create or enforce a lien or engage in any collection efforts (calls, letters, accelerating a debt, sending out the sheriff) with respect to such pre-petition claims.

There are three major types of bankruptcy under the Bankruptcy Code, located at Title 11 of the United States Code. While we identify and briefly discuss each of these types of proceedings below, the most important information appears in the Sections discussing “Types of Claims: Who Gets Paid First” and “Filing a Claim: How to Get Paid”.

In certain limited circumstances (such as when the creditor may have a security deposit or other collateral), a creditor may file a motion with the court requesting the court to lift the automatic stay to permit the creditor to take certain actions that would otherwise be prohibited by the automatic stay.

As noted there, claims for amounts owed for services almost always will fall into the category of unsecured claims, meaning in most cases claims for dental services will be lumped together with all other unsecured claims (credit cards, utilities, cell phones, etc.), most likely resulting in a recovery of far less than the value of the services provided.

Creditors are paid according to the legal priority of their claims.

a) Applies to both individuals and businesses. This is the most likely form of proceeding for individual patients whose liabilities substantially exceed their assets. b) A debtor who is unable to pay creditors can file a petition in a bankruptcy court. c) The court appoints a trustee to conduct the liquidation of all of the debtor’s assets. d) The trustee’s first job is to recover and sell any property that the debtor has in excess of certain minimum amounts, so as to create a pot of cash to pay claims. e) Often in individual Chapter 7 cases, there is no such property. But when there is, the trustee will review claims that have been filed in the case and may object to claims that are overstated or filed in the wrong priority category. The court decides whether the trustee’s objections are valid. The trustee then distributes the pot of cash to the creditors in the order discussed below. f) Individual debtors can keep certain property (for example a car or home) but may discharge (completely erase) other debts. Some types of debt are not dischargeable such as child support, income taxes and student loans. Bankruptcy will remain on an individual debtor’s credit report for 10 years. g) Businesses are not able to discharge debts, but upon liquidation of the assets the business is dissolved thereby rendering any unpaid portion of creditors’ claims worthless. 2. Chapter 11: Reorganization or liquidation of businesses a) Applies primarily to businesses, but can also apply to individuals with substantial debts and assets (for purposes of this primer, financial rehabilitation for individuals will be addressed under Chapter 13, see below). It is unlikely that many patients would be involved in this type of proceeding. b) The purpose of Chapter 11 is to reorganize or sell a business as a going concern pursuant to a plan of reorganization or liquidation, as applicable. In order to be adopted, the plan must be voted on by creditors and approved by the bankruptcy court. c) In Chapter 11 reorganization, the debtor will continue to operate its business upon emergence from bankruptcy. d) Liquidations under Chapter 11 differ from liquidations under Chapter 7. In Chapter 7, once the business enters bankruptcy it ceases operations and its assets are liquidated. Under Chapter 11 liquidation, the debtor continues to operate the business for a period of time to maximize the value of the assets, but ultimately the assets are sold (often times as a going concern). e) In Chapter 11 reorganizations and liquidations, the debtor’s management usually remains in place during the bankruptcy proceeding.

1. Secured claims – A secured creditor is a creditor who holds a properly perfected security interest in property of the debtor (for example, a bank holding a first mortgage on the creditor’s home will be paid before a credit card company that does not hold a security interest in any property of the debtor). Generally, a security interest is evidenced by a document filed or recorded in the state where the individual resides (or in the case of a company, the state of incorporation) and providing that if the debtor is unable to repay the amount owed, the creditor can take the collateral (the property the debtor pledged to secure the debt). Secured claims are paid from the proceeds of the collateral securing them before any other claims. 2. Undersecured claims – Undersecured claims are claims where the value of the collateral (the debtor’s property securing a creditor’s claim) is worth less than the debt owed. For example, a bank holds a $200,000 mortgage on the debtor’s home which is only worth $175,000. In such cases, the secured creditor is secured only to the value of the property with the balance of the debt being considered along with the claims of unsecured creditors, in this case, the remaining $25,000.

Frequently Asked Practice and Legal Questions

1. Chapter 7: Liquidation

Types of claims: Who gets paid first?

3. Administrative expenses – This includes the costs of operating the business while in bankruptcy or costs associated with the bankruptcy proceeding. 4. Priority unsecured claims – This category of claim is a statutory creation that protects claims such as certain accrued but unpaid employee wages and taxes. 5. Unsecured claims – This category includes the claims of all unsecured creditors (i.e., those that do not hold a security interest in property of the debtor). This is the category of claim which receives the lowest priority and results in the lowest level of repayment, often pennies on the dollar. Most, if not all, dental bills will fall into this category. Filing a claim: How to get paid Once a debtor files a bankruptcy case, you should receive a written notice of the case and of the deadline by which you must file your claim with the court. The deadline is often called the bar date. Claims must be filed before the bar date or else the claim will be permanently barred. Filing the claim is relatively simple. Filing information is often provided with the notice of the bankruptcy case. You should attach any documentary evidence you have regarding the claim (such as invoices or other documents substantiating the amount the debtor owes). The debtor and/or trustee may object to a claim, but is unlikely to do so if appropriate documentation is provided. Objections may be heard by a judge, but more often are negotiated informally. Once the court has approved payment amounts, the excess amount of your claim is deemed to be “discharged” (i.e., the debtor has no further obligation to pay). 2014 WDA Sourcebook

Frequently Asked Practice and Legal Questions Preference: When payment may NOT be a good thing 1. One philosophy behind the Bankruptcy Code is unsecured creditors should be treated equally. If one creditor receives a payment shortly before the debtor declares bankruptcy, other creditors may suffer disproportionately.

Frequently Asked Practice and Legal Questions

2.Therefore, if a debtor makes a payment to a creditor within 90 days prior to filing for bankruptcy, and if the payment amounts to more than what the creditor would have received as a distribution from the bankruptcy estate, the creditor may be forced to return that payment called preferential payments.

FOLLOWING A DIVORCE, WHICH PARENT HAS THE RIGHT TO MAKE TREATMENT DECISIONS ON BEHALF OF A MINOR CHILD? The ability to make decisions regarding treatment of a minor child depends on which parent has legal custody of the child. In cases where the parents have joint legal custody, they each have the right to make decisions (just as they did when they were together prior to the divorce).

3. Often the debtor or trustee will send creditors that received preferential payments a letter demanding return of the preferential payments. If the issue is not resolved through negotiations, the debtor or trustee may file a lawsuit in the bankruptcy court requesting an order directing the creditor to return preferential payments.

Physical custody alone does not necessarily determine legal custody.

4. Possible defenses to a preferential payment include demonstrating that: a) The payment was made in the ordinary course of business conducted between the debtor and creditor. For example, the patient/debtor promptly paid upon receipt of the creditor’s bill, just as the patient generally has done in the past.

The only way to be absolutely certain regarding the parent’s respective rights and authority is to request the parent bringing the child to the office also bring copies of all documents relating to custody and medical expenses of the child (e.g., divorce decree, separate custody decree or agreement, document referencing child care expenses or insurance coverage).

b) New value (new goods or services) was provided to the debtor after the date that payment was made and the new goods or services were not paid for at the time the debtor filed its bankruptcy case. For example, the patient paid a $500 bill late 89 days before a bankruptcy filing, but failed to pay a $200 bill incurred 60 days before the filing. In this case, the $500 preference claim will be reduced to $300.

It may be uncomfortable to ask for documents – but not as uncomfortable as dealing with an angry parent who is claiming you acted improperly by taking instructions from the wrong person when you provided treatment. IF A DIVORCED PARENT IS DELINQUENT IN PAYING FOR A CHILD’S DENTAL EXPENSES, CAN I CONTACT THE OTHER PARENT TO COLLECT?

c) A third defense is a contemporaneous exchange for new value, meaning the debtor/patient paid at or about the same time as the goods or services were provided (cash-in-advance or payment for services at the time provided).

The answer to the question of responsibility between divorced parents for a minor child’s dental expenses is similar to the treatment decisions question above – it depends.

5. If you suspect bankruptcy is imminent: a) Don’t use pressure-filled collection tactics, follow the normal payment pattern. b) Switch to a cash-in-advance payment system. Dealing with a patient after filing The bankruptcy filing affects only those debts incurred by the patient prior to the filing and consequently, once a patient has filed, charges for new services provided after the filing date would not be affected by the bankruptcy proceeding. That being said, a patient who has just completed or is engaged in a bankruptcy proceeding may be one you wish to service only on a “cash” basis. If you choose to dismiss the patient due to non-compliance of treatment (failure to pay for treatment can be categorized as noncompliance), then you should follow proper dismissal protocols to avoid patient abandonment. 2. CHILDREN OF DIVORCED PARENTS CAN A STEP-PARENT ACT ON BEHALF OF A MINOR CHILD TO PROVIDE INFORMED CONSENT AND AUTHORIZATION FOR DENTAL TREATMENT? Prior to treating a minor child, you must obtain informed consent from a parent, guardian or legal custodian of the child. Wisconsin law defines a “parent” as a: • Biological parent • Husband who has consented to artificial insemination of his wife • Parent by adoption • Father who has had his paternity established in accordance with applicable law Unless a step-parent independently satisfies this definition (for example by adoption), a step-parent is not a “parent” under Wisconsin law and cannot provide informed consent to treat a step-child. CAN I SHARE INFORMATION RELATING TO A MINOR CHILD WITH HIS OR HER STEP-PARENT? Generally not, unless the step-parent has formally adopted the child. Information relating to a minor child cannot be shared with a step-parent, unless a step-parent formally adopts a child. Information included within dental records is treated as HIPAA-protected health information. HIPAA permits the disclosure of a child’s protected health information only to a parent, guardian or other individual authorized to make decisions regarding the child’s health care decisions. Because a step-parent is not generally authorized to make health care decisions for a step-child, a step-parent may not have access to a step-child’s dental records absent formal adoption of the child.

However, the parent of a minor child who has the right to view the child’s records can provide a written consent to permit disclosure of the child’s dental records to a step-parent.

2014 WDA Sourcebook

Normally, parents will have joint legal custody unless one of them has been denied visitation with the child (in which case the denied parent would normally not have joint custody for purposes of deciding on dental care).

Generally, payment should be sought from the parent with the court-assigned responsibility for the expenses. As with treatment decisions, the only way to be absolutely certain which parent is responsible is to request the parent bringing the child to the office provide copies of all documents relating to custody and medical expenses (e.g., the divorce decree, separate custody decree, document referencing child care expenses or insurance coverage). Those documents should tell you who is legally responsible for the expenses, but they will not necessarily answer the question of whether you can contact the other parent for payment. Even if not legally responsible, the other parent may be willing to pay. However, you cannot request payment from the non-legally obligated parent unless that parent has the right to access the child’s dental records. If the non-obligated parent has records access (i.e., joint legal custody or has been given permission, preferably written, by the other parent to have records access), you can request payment. The non-legally obligated parent cannot be required to pay even if they have records access – but there is seldom any harm in asking. An alternative for dealing with a non-legally obligated parent with access to records might be to request that he or she sign a statement in advance of treatments agreeing to be financially responsible. The parent may or may not be willing to sign depending on the situation, but signing makes them responsible and, again, there is seldom any harm in asking. A general rule of thumb to start with is the parent who signed the child’s health history and treatment plan, is generally (minus the knowledge of court orders) the parent responsible to pay the bill. HOW ARE INSURANCE BENEFITS COORDINATED FOR A CHILD OF DIVORCED PARENTS? When a child is covered by more than one benefit plan, it is necessary to determine which pays first to avoid duplication of benefits. As a general rule, coordination of benefits depends on the benefit or insurance plans involved and the surrounding circumstances. This is particularly true for self-funded plans and individual insurance contracts, where you may need to review the terms of the contract or plan document to determine benefit coordination. Wisconsin law establishes specific guidelines for group insurance plans covering children of divorced parents. Pursuant to the guidelines, when one parent has been assigned responsibility for the child’s dental expenses by a divorce decree or other court order that group plan will be obligated to pay first if the plan has actual knowledge of the assignment. If there is no divorce decree or court order assigning responsibility for dental expenses between the parents, benefits under two or more group plans covering the child are paid as follows: 1. The group plan of the parent with physical custody of the child pays. 2. The group plan of the spouse of the parent with physical custody of the child pays. 3. The group plan of the parent not having physical custody of the child pays (assuming there is joint custody and/or liability on the part of that parent to begin with).

Frequently Asked Practice and Legal Questions If parents have joint physical custody, but neither has been assigned responsibility for the child’s dental expenses (or if the divorce decree makes both parents responsible for expenses related to the child’s dental treatment, but only one has physical custody), the group plan that pays first is determined in accordance with the “birthday rule.” The birthday rule relies on the month and day of each parent’s birth, without regard to the year, and operates as follows: 1. The group plan benefits of the parent whose birthday falls earliest in the year pays first. 2. If both parents have the same birthday, the benefit of the group plan that has covered a parent the longest pays first. 3. If the secondary group plan specifies it does not use the birthday rule and instead has a rule based on gender of the parent, and if, as a result, the coordination of benefits provision of the group plans conflict, the birthday rule does not apply and rule of the secondary group plan determines the order of benefits. The above is intended to provide general guidance on how benefits may be coordinated between two or more group plans. Other more specific rules may apply under special circumstances such as, where one parent has lost a job or has continuation coverage. Accordingly, it may be necessary in such cases to refer to the applicable provisions of Wisconsin law (generally Wisconsin Administrative Code INS 3.40(11)) and/or to the specific terms of the group plan policies involved. 3. DELEGATION OF DUTIES CAN DENTISTS DELEGATE THE USE OF LASERS BY DENTAL HYGENISTS?

Training is required, including a hands-on proficiency course provided by a recognized continuing education sponsor. Documentation of proof of training should be maintained.

Wisconsin Administrative Rules Chapter DE 12 – Delegation of Functions to Unlicensed Persons DE 12.01. A dentist may not delegate any dental procedure of any description to an unlicensed person if the procedure to be delegated: • Is of a character which may cause damage to the patient’s teeth or any oral cavity which cannot be remedied without professional intervention. • Is of a character which may cause adverse or unintended general systemic reaction. • Is intended, interpreted or represented to be preliminary assessments, dental hygiene treatment planning, oral screenings, oral prophylaxes or any portion of prophylaxis, other than supragingival rubber cup and air polishing after calculus is removed if necessary, scaling or root planning or dental sealants. DE 12.02. A dentist who delegates any dental procedure or function to an unlicensed person must first train or verify the training of the person in the performance of the procedure or function, and must maintain verifiable records on forms approved by the board of the successful completion of the training by the unlicensed person. A copy of a DEB-approved dental assistant training form can be obtained from the WDA Legislative Office at 888-538-8932. DE 12.03. A dentist or dental hygienist who becomes aware that any dentist is improperly delegating the performance of any dental procedure or function to an unlicensed person, or to a person who is performing the delegated procedure or function in a manner which is less than minimally competent, shall report the circumstances to the board. Failure to report the circumstances of improper delegation by a dentist constitutes aiding and abetting the violation of a law substantially related to the practice of dentistry or dental hygiene, and is a violation of DE 5.02(20). DE 12.04. An unlicensed person may remove may remove plaque and material alba with a mechanical device only if the delegation of the function complies with ss. DE 12.01and 12.02. WHAT IS THE SCOPE OF PRACTICE AND LIMITATIONS FOR DENTAL HYGIENE? According to Chapter 447 of Wisconsin statutes, Section 447.01(3) (a-g), dental hygiene means: • Removing supragingival or subgingival calcareous deposits, subgingival cement or extrinsic stains from a natural or restored surface of or a fixed replacement for a human tooth. • Deep scaling or root planning a human tooth.

WHAT ARE THE STATE STATUTES RELATING TO DELEGATION OF DUTIES TO A DENTAL ASSISTANT? Chapter 447-Wisconsin Statutes Section 447.065 Delegation of Remediable Procedures and Dental Practices 1. A dentist who is licensed to practice dentistry under this chapter may delegate to an individual who is not licensed under this chapter only the performance of remediable procedures (“remediable procedures” are defined under 447.01(12) as “patient procedures that create changes within the oral cavity or surrounding structures that are reversible and do not involve any increased health risks to the patient”), and only if all of the following conditions are met: 1. The unlicensed individual performs the remediable procedures in accordance with a treatment plan approved by the dentist. 2. The dentist is on the premises when the unlicensed individual performs the remediable procedures. 3. The unlicensed individual’s performance of the remediable procedures is subject to inspection by the dentist. 2. Subject to the requirements under s. 447.06(2), a dentist who is licensed to practice dentistry under this chapter may delegate to a dental hygienist who is licensed to practice dental hygiene under this chapter the performance of remediable procedures. 3. A dentist who delegates to another individual the performance of any practice or remediable procedure is responsible for that individual’s performance of that delegated practice or procedure. WHAT CAN A DENTAL ASSISTANT DO? The Dental Practice Act/Administrative Rules are not written in a list form outlining the duties that can be performed by a dental assistant. However, the dentist can use the following set of guidelines to determine what can be done.

• Conditioning a human tooth surface in preparation for the placement of a sealant and placing a sealant.

Frequently Asked Practice and Legal Questions

In March 2012, the Dentistry Examining Board approved a position statement allowing dentists to delegate the use of lasers by dental hygienists as an adjunct to scaling and root planing.

Additional questions may be directed to the WDA Legislative Office at 888-538-8932 or mbrooks@wda.org.

• Conducting a substantive medical or dental history interview or preliminary examination. • Conducting an oral screening without the written prescription of a dentist. • Participating in the development of a dental patient’s dental hygiene treatment plan. • Dispensing oral premedications under the direct supervision and delegation of the dentist (see section below). • Administering local anesthetic under the direct delegation and supervision of the dentist. • Any other practice specified in the rules promulgated under 447. Section 447.06(2) (d) states: “A dental hygienist may not diagnose a dental disease or ailment, determine a treatment or any regimen of any treatment outside of the scope of dental hygiene, prescribe or order medication or perform any procedure that involves the intentional cutting of soft or hard tissue of the mouth by any means.” CAN A REGISTERED DENTAL HYGIENIST SEE PATIENTS OF A DENTAL PRACTICE WITHOUT THE DENTIST PRESENT? Chapter 447 – Wisconsin Statutes Section 447.06(2) (c) (1-4) Practice Limitations Yes, only if all of the following conditions are met: • Patient is a patient of record for not less than six months. • Patient gives consent to be treated when the dentist is not on the premises. • Hygienist is acting under the written or oral prescription of the dentist. • Patient has been examined by the dentist within the last 12 months. 2014 WDA Sourcebook

Frequently Asked Practice and Legal Questions UNDER WHAT CIRCUMSTANCES CAN ADMINISTRATION OF LOCAL ANESTHETIC BE DELEGATED TO A DENTAL HYGIENIST? A dentist can delegate the administration of local anesthetic to a dental hygienist only if ALL of the following criteria have been met: • The dental hygienist is certified to administer local anesthetic in Wisconsin under s.447.04 (2)(c)1 (certification is obtained from the Dentistry Examining Board – educational requirements are found in DE Rule 7). • The delegation is pursuant to a treatment plan approved by the dentist. • The dentist remains on the premises and available to the patient throughout the completion of the entire appointment. Dental hygienists can obtain the necessary education for obtaining certification in the administration of local anesthetic from a Wisconsin technical college that provides dental hygiene education. 4. DENTAL RECORDS DOES AN EMAIL REQUEST FROM A PATIENT PROVIDE APPROPRIATE AUTHORIZATION FOR A RELEASE OF RECORDS OR MUST THE REQUEST INCLUDE THE PATIENT’S SIGNATURE?

Frequently Asked Practice and Legal Questions

HIPPAA and Wisconsin law provide that an authorization to release medical records must include the signature of the individual making the request (which may be the patient, an authorized agent of the patient, or an appropriate court appointee). The signature may be an original, a copy of the original, or a signature received via fax or in the form of a PDF attachment to an email. However, given the increased sensitivity to patient confidentiality and the ability for anyone to make an email request via the Internet, we do not believe such a request (absent a PDF signature) is itself sufficient in the face of specific statutory language requiring a signature. While e-signatures may be sufficient to create binding contracts under Wisconsin law in some circumstances, we do not believe they should be relied upon as authorization for the release of patient records at this time. HOW LONG MUST I KEEP PATIENT RECORDS? There is no set requirement for how long you must retain patient records. Generally, from a legal perspective, you should keep patient records for at least as long as necessary to protect yourself in the event of a claim or lawsuit by a patient. That period is determined by the statute of limitations which is the time period when a claim must be brought. Any of several different statutes of limitations may apply, depending on the alleged injury and the legal theory under which the action is brought. For example, if a patient alleges a breach of contract to provide reasonable care, the suit must be brought within six years of the breach. If a patient alleges an intentional tort (such as libel, slander or even purposeful mistreatment), the statute of limitations is two years. The statute of limitations is extended for an additional year if the person entitled to bring the action dies before the original statute of limitations has expired (allowing the deceased’s estate to pursue the claim). In dental malpractice actions, a patient must file a claim before the later of: • Three years from the date of injury • One year from the date the injury was, or could have been, discovered with reasonable diligence, but in no event more than five years after the event. There are a number of exceptions to this statute of limitations. For example, the five-year limit does not apply if the provider concealed the injury, or if a misdiagnosis occurred more than five years before discovery of the injury. If a minor is not yet 10 years old when the statue of limitations expires, the limitations period is extended until the minor’s 10th birthday. Finally, if an adult or minor patient is insane or imprisoned, the statute is extended until two years after the disability ceases or the person is released. The various statutes of limitations and numerous exceptions make it difficult to determine the applicable claim period for any particular patient. Accordingly, it is hard to identify a specific period after which disposal of records poses absolutely no risk. Permanent retention of records poses the least risk, but may be impossible or impracticable. A policy of retaining patient records for the life of the patient plus one year is also a reasonable alternative. If neither of these are practical, we would recommend patient records be retained

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for no less than 10 years from the date of treatment for patients who are no longer active (records of active patients should be kept). Complex records of patients who received extensive treatment should also be kept. (NOTE: The Dental Examining Board is working to create an administrative code to address a specified timeframe required for record retention. ie: 10 years from the last date of service. This should be finalized sometime between 2014 - 2015.) DOES MEDICARE HAVE ITS OWN RECORD RETENTION REQUIREMENTS? Although there are few dental procedures covered under the federal Medicare program for people over 65 years of age, dentists should be aware these regulations require providers to retain clinical records for at least five years (or as determined by state law or the state statute of limitations). Note this five year requirement does not override our prior suggestion that records be retained for at least 10 years from a legal liability standpoint. In addition, the Federal False Claims Act provides a plaintiff may not bring a claim under the Act more than 10 years after the alleged violation was committed. Thus, a dental practice that retains patient records for the recommended minimum of 10 years will also be in compliance with both the Medicare requirements and the statute of limitations for the act. MUST I FOLLOW ANY SPECIFIC PROCEDURES WHEN DISPOSING OF PATIENT RECORDS? Even after the applicable record retention period expires, the disposal of records remains subject to the requirements of Section 895.505 of the Wisconsin Statutes. Your records contain what the statutes refer to as personal information relating to the patient (i.e., medical conditions, treatments, address, Social Security number, etc.) which the statutes seek to protect. Before disposing of patient records, you must either shred the records, or modify them by erasing personal information or otherwise making it unreadable. Of the alternatives, shredding records seems far more practical than altering. Dental models are also considered part of the patient record in which any name or patient information on the models must be made unreadable prior to disposing as well. In addition, you must take steps to ensure none of the personal information in any disposed records can be accessed by any unauthorized person prior to destruction. Failure to comply with these requirements could result in a fine of up to $1,000 per patient plus liability if the patient suffers damage as a result of the information being seen by unauthorized persons. WHO ‘OWNS’ A PATIENT’S DENTAL RECORDS? The dentist owns the records, but the patient owns the information contained in the records. As such, the patient has a right to examine and/or obtain a copy of their records at any time. Statute 146.83, Patient Access to Health Care Records provides a patient (or person authorized by the patient) has the right to inspect his or her own dental records during regular business hours if he or she gives reasonable notice to the dentist of a desire to inspect and submits a signed statement of “informed consent” stating the purpose of the inspection, the type of information sought, the name of any person authorized to inspect or receive the information and the date. The patient may obtain copies of the dental records by paying a reasonable copying cost defined in WI statute shall the dentist want to charge. A person authorized to inspect or receive the information on behalf of a patient includes a parent, guardian, custodian or an agent. The dentist is not required to and should not relinquish physical possession of the original records. But the dentist has the absolute legal duty to comply with the request for a copy or transfer of the records to whomever the patient desires with little or no interference. WHO HAS A RIGHT TO ACCESS THE RECORDS OF A DECEASED PATIENT? HIPAA’s privacy requirements continue to protect a patient’s records even after the patient’s death. Since Wisconsin does not impose duties more stringent than those under HIPAA, those requirements set the standard. Following a patient’s death, the right to request and review records passes to the deceased’s personal representative. Before allowing this person access to records, you should require the person seeking access to present court certified documentation (referred as domiciliary letters or testamentary letters) naming or appointing the requesting individual as the deceased’s personal representative. Alternatively, if the deceased already had a personal representative before death (as might be the case where an appointment was made because of the patient’s advancing age or concerns about mental competence) that personal representative – who again must provide court certification showing earlier appointment as the deceased’s guardian or personal representative can access the deceased’s records.

Frequently Asked Practice and Legal Questions Similarly, the parent of an unemancipated minor (assuming a normal parental relationship where the parent had authority to access the minor’s records during life) may continue to access records after the minor’s death even without a court appointment. There are also instances where a deceased’s records may be provided to particular persons or agencies under specified circumstances. These include: • If ordered by a court or authorized agency • Pursuant to a subpoena • To law enforcement agency to alert those of the death if you believe death resulted from criminal conduct • To a coroner or medical examiner if necessary for identification or to determine a cause of death • To funeral directors to the extent necessary to the discharge of their duties • To organ procurement organizations authorized to act with respect to the body • To a public health authority collecting information for disease control purposes WHAT HAPPENS TO PATIENT RECORDS IF I RETIRE OR LEAVE THE PRACTICE? If you retire or otherwise leave practice, Section 146.819(1) of the Wisconsin Statutes requires you to provide for either the maintenance or destruction of patient records. You can provide maintenance through a written agreement with someone who assumes the obligation to maintain the records.

Alternatively, you may choose to destroy the records – remembering your obligation (See question about following specific procedures when disposing of patient records) to protect personal information in the process. No matter which option you select, the statute requires you to give notice to patients by either first class mail, or publication of a class 3 notice in the local paper. If you are destroying the records, notice must be given at least 35 days before the records are destroyed. The notice must also give patients the dates, times and a location at which they can retrieve their individual records prior to destruction. Note, even in the case of retirement, we recommend a 10 year record retention period prior to destruction. You can still be sued for something that happened while you were practicing even after retirement.

If there is a remaining entity, it would seem appropriate to have a simple agreement signed by the parties and agreeing patient records will be kept confidential. Preferably the agreement would reference compliance with Sections 146.81 to 146.835 of the statutes and indicate the records are being provided to the departing practitioner to permit him or her to continue to provide care to the patients whose records are involved.2 We believe use of a simple agreement will give an added degree of protection to the dentists involved by documenting both the intent that the records be kept confidential and statutory compliance with the provision allowing the transfer of records to allow ongoing treatment. Another scenario might be where the departing dentist is an employee of a practice that will continue with one or more other dentists remaining. While this situation raises the issue of ownership – do the records belong to a dentist or to the continuing practice –treatment could be the same as suggested above if the separation is amicable and it is agreed the departing dentist will keep his or her own patients of record. Section 146.82(2)(a)2.a. would still permit the record transfer on the basis that the departing dentist will be providing assistance to the patient. Again, since the dentist is familiar with the records already, his or her possession of them should not present a confidentiality issue. Lastly, in this situation as well, we would recommend a form of agreement similar to that suggested above. If, however, the employee dentist’s departure involves a dispute as to whether patients are the employee’s or the practice’s, the practice may (depending on the facts, circumstances and on whether there has been any agreement with the former employee regarding the division of patients upon departure) be within its rights to assert that the records are the property of the practice and cannot be transferred. In such cases, the retention or transfer of records will need to be resolved by negotiation or, absent agreement, by more formal legal proceedings. Remember again, patients have at all times the right to request copies of their records and to give them to whomever they choose. We would note two additional concerns related to the transfer of patient records in connection with the division of a practice. First, the WDA recommends the records be copied so the departing dentist and remaining dentist or practice has identical patient files. That way, the continuing practice or remaining dentist(s) will have records if they become necessary in the future. For example, if a disgruntled patient were to sue the treating dentist for a prior event, but also names the remaining practice or dentist(s) on the grounds they were part of a joint practice at the time the event occurred. Secondly, we believe the affected patients should be advised in advance the departing dentist will be taking/retaining their records. The notice should give them an opportunity (at least 35 days) to object. The notice should also advise the patient:

HOW SHOULD PATIENT RECORDS BE HANDLED WHEN DENTISTS DIVIDE A PRACTICE? CAN THE RECORDS SIMPLY GO WITH THE DENTIST WHO HAS BEEN CARING FOR THE PATIENT?

• The departing dentist is retaining the records since he/she was the one who provided the patient with services in the past

The answer depends, to large extent, on the specific facts and on whether the division of the practice is amicable. While we will address several possible scenarios, remember no matter what the situation may be, each patient has a right under Section 146.83(2) to request and receive a copy of their own individual records.1

• Where the records are now located,

While perhaps not feasible in actual practice, the most clear-cut approach would be to provide each patient with a form they can use to direct and authorize the disposition of their individual records to a specific dentist or to his or her practice. Assuming individual patient direction is either not practicable or obtainable, the simplest scenario is one where a practice is divided amicably and with the understanding that each of the dentists will continue to treat those individuals who were their respective patients of record. In such cases, we believe it should be permissible for the treating dentist to take the records (or record copies) relating to his or her patients without worrying about potential “ownership” issues (e.g., do the records “belong” to the partnership or entity rather than to a particular dentist, what happens if the practice entity – partnership, LLC, etc. – is dissolved, what if the departing dentist was an employee and the dental practice employer continues to exist as an entity). This result seems to be correct because Section 146.82(2)(a)2.a. permits the transfer of records, without patient consent, to a licensed health care provider who is rendering assistance to the patient (expected to be the case where the dentist taking records has been the one

Frequently Asked Practice and Legal Questions

The most common form of this arrangement would be in connection with the sale or assumption of a practice, where the incoming dentist would agree to maintain the records. Section 146.819(1)(a) specifies the person maintaining the records must agree to keep them in accordance with Sections 146.81 to 146.835 of the Statutes and we would recommend that reference be made to those sections in the agreement itself.

providing treatment in the past), and the treating dentist is already familiar with his or her patient’s records, so there is no breach of patient confidentiality.

• Retention of the records will allow him/her to continue to provide continued treatment in the future • The patient has the right to request and obtain copies of their records if they so desire MAY I DENY PATIENTS ACCESS TO THEIR DENTAL RECORDS BECAUSE THEY OWE A BALANCE ON THEIR ACCOUNT? MAY I CHARGE FOR PROVIDING COPIES OF RECORDS? Electronic requirement: No and yes. In a prior case involving this exact question, the DEB fined a dentist for refusing to provide patient records because of a past due balance. Section 146.83(2) of Wisconsin Statutes further provides at the time you first treat a patient, you must give them a written statement advising them they have a right to their records. Although the statement need not advise the patient they can get their records even with an outstanding balance. The statute provides the written statement given to patients is to “paraphrase the provisions” of Section 146.83(1), which states generally patients have a right to their records. The state budget act (2011 Wisconsin Act 32) signed by Gov. Scott Walker increased the maximum statutory fess that a health care provider may charge for copies of patient health care records.

Thus, if dentist A and dentist B split their practice, even if they agree that dentist A will keep patient C’s records, C can request a copy of the records and give them to dentist B. Even if the dissolution is as simple as a two-person partnership which will itself cease at the time of the separation, the WDA still suggests a two-person agreement referencing the records.

1 2

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Frequently Asked Practice and Legal Questions Actual fees are determined by the health care provider, but cannot exceed these maximum charges: • For paper copies: o $1.04 per page for the first 25 pages o $0.77 cents per page for pages 26 to 50 o $0.52 cents per page for pages 51 – 100 o $0.31 cents per page for pages 101 and above • For microfiche or microfilm copies: $1.55 per page

The state has no specifically authorized provisions for disclosure of records to law enforcement officials other than those related to child abuse. Section 146.82(2) of the Wisconsin Statutes describes a number of instances where records can be given, without patient consent, to different government agencies. You may wish to review those exceptions depending on the situation; however, none of the exceptions would cover a general request from the police.

• If the requester is not the patient or a person authorized by the patient: A single $8.26 charge for certification of copies and a single retrieval fee of $20.65 for all copies requested

The Wisconsin provision most likely to apply in police situations is Section 146.82(a)

Dentists are prohibited from charging full fees to MA patients: Under this section, a health care provider may not charge more than 25 percent of the applicable fees (listed above) for providing one set of copies of a patient’s health care records if the patient is eligible for medical assistance (previously, one set had to be provided free of charge). A health care provider may require that a patient or patient’s personal representative provide proof that the patient is eligible for medical assistance before providing copies without a full charge. The reduced fee requirement does not apply if the health care provider is the DHS or the Department of Corrections.

Frequently Asked Practice and Legal Questions

In terms of law enforcement-related record disclosure, HIPAA is generally more liberal than state law, making Wisconsin’s more restrictive limitations the controlling ones.

• For print of X-ray: $10.32 per image

Plus actual shipping costs and any applicable taxes.

A health care provider may charge the full fees that are allowed (listed above) if providing a second or additional set of copies of patient health care records for a patient who is eligible for medical assistance. Sales taxes, if applicable, may also be added to the fee limits. When records are needed by or on behalf of indigents, the state DHS encourages health care providers to provide those records at as low a cost as possible. On July 1 of each year, DHS shall adjust the dollar amounts specified in this section by the percentage difference between the consumer price index for the 12-month period ending Dec. 31 of the preceding year and the consumer price index for the 12-month period ending Dec. 31 of the year before the preceding year. The adjustment to the allowed charges for copying records will be published in the Wisconsin Administrative Register. You should provide only copies, being certain to retain the originals for your files. While you cannot withhold records for past due fees, there is nothing to prevent you from taking steps that might increase your chances of collection. For example, you could tell a patient seeking records there is an outstanding fee (and/or copying charge) you expect to be paid when they pick up the records. But, you cannot then withhold the records if they show up to obtain them and still do not pay. IS A RECORD RELEASE FORM REQUIRED? The most normal incident of record transfer is from one dentist to another dentist or doctor. In these cases, neither Wisconsin law nor HIPAA require a record release form. If release of record is for treatment, payment or health care operations an authorization from the patient is not needed (also known as the TPO Guidelines). If release of records is for the patient making the request, a signed authorization is not needed. However, if release of records is for any other situation, a signed consent form is needed. A record release form is available to dental offices for a person to complete prior to the release of records to the designated person or dental office. All releases of any patient information needs to be documented in the patient record. To obtain a copy, call the WDA Legislative Office at 888-538-8932 or email evaladez@ wda.org. I HAVE BEEN ASKED BY THE POLICE DEPARTMENT FOR A PATIENT’S DENTAL RECORDS. SHOULD I PROVIDE THEM? Both HIPAA and the Wisconsin statutes protect the privacy of patients’ dental and medical records except in certain limited situations. In fact, HIPAA and Wisconsin protections are not identical. In the absence of patient consent, you may disclose records only where such disclosure is

permissible under both HIPAA and Wisconsin law (such as the child abuse situation to be discussed in next Q&A).

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(4), which authorizes you to provide records pursuant to a court order. Thus, if you are requested by a law enforcement agency to provide records, our advice generally would be to respond in a helpful and courteous fashion, let them know you will do whatever you can to help, but then explain your general confidentiality requirement and ask them to identify a specific statutory provision that would allow you to make the records available. If they are unable to identify a specific statutory provision (as we expect will be the case in virtually all situations), you should again let them know you want to help and would be happy to provide whatever they need pursuant to a court order. 5. DOMESTIC ABUSE AM I PERMITTED TO REPORT SUSPECTED CHILD ABUSE IF I OBSERVE SYMPTOMS DURING MY TREATMENT OF A PATIENT? You are not only permitted, but required by Wisconsin Statute §48.981(2) to report suspected instances of child abuse or neglect. HIPAA also permits that disclosure, since 45 C.F.R. §164.512 authorize disclosures “otherwise required by law”. Abuse is broadly defined to include physical, emotional and sexual abuse. Neglect means, “…failure, refusal or inability on the part of the parent or other legal custodian for reasons other than poverty (emphasis added) to provide necessary care, food, clothing, medical or dental care or shelter so as to seriously endanger the physical health of the child.” If you suspect neglect or abuse, you should report the circumstances to the local county health department, county sheriff or local police department. The authorities may require a subsequent report in writing. Within 24 hours of receiving the report of abuse or neglect, the agency/county is required to begin an investigation. Within 60 days, the agency/county is to inform the reporting dentist of any action taken. Section 48.981(4) provides immunity from lawsuits to a professional submitting a report, as long as the report is made in good faith. For the parents of the child (or anyone else) to successfully sue a dentist for defamation or false reporting, they would need to be able to show clear and convincing evidence that you were acting badly (e.g., you had some reason for making a false report – quarrels, personal dislike or trying to pressure a patient to pay a bill). If lack of dental care is the cause for the concern, the dentist should consider before making the report whether the lack of care equates to “neglect” (i.e., seriously endangers the health of the child). Consider whether an ordinary person (not a dentist) would define the situation as “neglect”. For example, a failure to pay for braces or treat minor caries may not rise to the level of what an ordinary person would generally understand as neglect, while even non-dentists would agree that a failure to deal with widespread or advanced decay, pain and/or oral infections would qualify. Lastly, you do not need to be the authority that determines if “poverty” is the reason for neglect. The presumption that you are reporting in good faith would protect you even if the subsequent investigation shows that the parents were too poor to prevent the neglect. It is the dentist’s responsibility to report the suspicion of abuse and/or neglect and then let the investigating agency determine whether it occurred. If so, whether it was excusable based on poverty. ARE THERE DIFFERENT REPORTING CONSIDERATIONS IF I OBSERVE SYMPTOMS OF DOMESTIC ABUSE OR VIOLENCE AFFECTING AN ADULT? Yes, Wisconsin’s treatment of child abuse is, from a dental perspective, considerably different from its treatment of adult abuse.

Frequently Asked Practice and Legal Questions As noted above, the state has a specific statute that requires reporting of child abuse by dentists and provides protection against civil liability if the reporting dentist issued. The statutory reporting requirement also works as a “state mandated” exception to HIPAA’s privacy requirements for the dental records of the child involved. Wisconsin treats adult abuse very differently – presumably because the patient is an adult and can take steps for their own protection. There is nothing in the statutes that either mandates reporting of adult abuse by dentists, or protects a dentist against a civil claim from a patient if a report is made or if HIPAA-protected medical records are disclosed without patient permission. Note: Section 146.995 of the Wisconsin Statutes requires the reporting of gunshot wounds by persons licensed under Chapters 441, 448 and 455 (nurses, physicians and psychologists) and permits them to report other wounds if they believe the wound was the result of a crime. Assault, including domestic assault, is a crime and thus can (but is not required to be) reported under this section. The section also provides civil liability protection if a report is made in good faith; however, since dentists are licensed under Chapter 447, this statute does not extend to them. Absent statutory protection, it is difficult to provide legal assurances to a dentist who might want to report adult/domestic abuse. Section 3.E. of the ADA Code of Ethics suggests an obligation to report domestic abuse, but then tempers it by adding that dentists are, “… obliged to identify and report suspected cases of abuse and neglect to the same extent as they are legally obliged to do so in the jurisdiction (state) where they practice.

HOW MAY A PRACTICE CARE FOR MA PATIENTS WITHOUT BECOMING OVERWHELMED? Dentists are not required to become a provider under the state’s MA program, but many dentists who do wish to participate are often reluctant to do so from fear of becoming overwhelmed with MA patients. This article will provide helpful hints on how dentists can limit their exposure to the financial aspect of the state’s underfunded program while providing quality dental care to those who are least able to afford it. The Wisconsin MA All-Provider Handbook specifically notes, “All providers have the right to limit the number of Wisconsin MA patients they see in their practice, except when providing emergency services.” The handbook also notes providers are required to comply with the applicable state and federal laws prohibiting discrimination based on age, race, color, handicap, sex, creed, national origin, ancestry, sexual orientation, arrest or conviction record, marital status, political affiliation or religion. The handbook adds methods used to limit the number of MA patients may not discriminate against or have the effect of discriminating against any individual based on any of the aforementioned legally protected classifications (e.g., age, race, color). While there are any number of nondiscriminatory methods that can be used to limit the number of MA patients in a practice, some approaches that may seem appropriate on their face could have an unintended discriminatory effect. For example, a Mequon dentist might decide to limit MA patients to those living in the 53092 ZIP code, because it is the area nearest to his or her practice and MA patients living nearby will be less likely to miss appointments.

There are no reported Wisconsin cases that would fill the statutory gap by extending protection against a lawsuit to a dentist who reported a case of adult abuse. Absent a state law exception, a report that included medical information and was not authorized by the patient would, in our opinion, also violate the patient’s HIPAA privacy rights.

However, if it could be shown the 53092 ZIP code area is primarily white, containing a disproportionately small cross-section of minority population groups. This method of limitation could be viewed by a court as having the effect of discriminating against minority groups.

Our best advice for dentists who believe they are aware of domestic abuse would be to meet their ethical and professional obligations by counseling with the patient, possibly even providing a list of local abuse-prevention organizations the patient could contact for further counseling.

These same considerations could apply if a practice were to limit MA patients by school district.

A more proactive approach might be to develop some kind of release/direction form a patient could sign requesting the dentist to report the situation to a named counseling agency and authorizing the disclosure of dental records. However, given the differences in patient situations, vulnerabilities and even emotional and mental condition, we believe such an approach would involve considerable risk and should be utilized only in extreme cases and with the advice of counsel. 6. MEDICAID AND DISCOUNTS WHAT IS MA AND WHY IS DENTIST PARTICPATION LOW? Medicaid is a program with 40 percent funding of state and 60 percent funding of federal tax dollars. Its purpose is to serve individuals and families who cannot afford private medical/ dental insurance and provide comprehensive care in order to prevent or treat illness. DHS works in conjunction with the state’s Legislature to establish the parameters of the services and it is the state Legislature that sets the reimbursement levels to MA providers. There are a number of reasons behind low dentist participation in the MA program, including low reimbursement and high no-show rates. However, changes in the current system will only come about by collective action from the state (Legislature and the DHS), MA patients and the dental community. Action by one of these entities without full participation from the other two will not be as successful as it could be if all three entities work together. Wisconsin lawmakers have chosen not to place a priority on improving funding for the dental MA program. It is for this reason that MA patients should be encouraged to correspond directly with their state legislators by phone, email or written correspondence about their concerns regarding the program. These communications can help reveal the numerous obstacles patients encounter when trying to find a MA-certified dentist, and could better illustrate the need for a comprehensive change to the current program. Elected officials need to be aware of the “reality” of the current situation in order to create policy that is in the best interests of the population they are trying to serve.

On the other hand, a ZIP code limitation may be perfectly acceptable if the dentist lives in an area (or selects some combination of zip codes) which contains a diverse population mixes. There are, nonetheless, a variety of methods that would limit the number of MA patients and also seem to be neutral in their effect on protected groups. These might include: • Taking only a set number of new MA patients in each month or year on a first-come, first-served basis. • Limiting MA patients to a set percent of the overall number of patients. If percent decreases, new MA patients would be added on a first-come, first-served basis.

Frequently Asked Practice and Legal Questions

The accompanying advisory opinion specifically warns about the countervailing concerns of respecting patient privacy and the extent to which immunity may be available under different state laws.

• Set aside certain practice hours during which MA patients will be seen (e.g., only before 2 p.m., only between 9 a.m. and 11 a.m., only on selected days of the week or on any similar basis that works within your practice parameters). • Keeping existing MA patients, but declining to add new MA patients. • Accept only children as MA patients. Although age is a “protected category” for purposes of some forms of discrimination (i.e., most notably age discrimination in terms of employment), it is not generally treated as a protected category for MA services. While we believe a broad age-based category-type distinction is permissible (e.g., children versus adults), the WDA recommends against using an age factor other than in a broad context. For example, we would not recommend using an age 50 cutoff for the acceptance of MA patients. If yours is a specialty practice, accepting only MA patients referred by another dentist. There are obviously other approaches if you wish to accept MA patients while imposing certain limits. Just be sure to structure your approach in a manner that does not have the effect of discriminating against a protected class of individuals. Before implementing a limitation, you should try to consider how the limit could have an unintended discriminatory consequence (e.g., the ZIP code limitation discussed previously). While there has been relatively little activity in terms of claims against dentists for refusing to accept patients, this is an issue that could become more of a problem in the future if there are changes in MA coverage, reductions in reimbursement levels or if access to dental services becomes even more difficult. The MA Provider Handbook defines and comments on emergency services as, “Emergency dental care is immediate service that must be provided to relieve the recipient from pain, an acute infection, swelling trismus, fever or trauma. 2014 WDA Sourcebook

Frequently Asked Practice and Legal Questions Prior authorization is not required in emergency situations. Wisconsin Medicaid waives the PA requirement for hospital calls, general anesthesia and IV sedation. These procedures are the only procedures PA is waived in an emergency. Certain services are covered only when they are provided under emergency circumstances. Refer to the MA handbook for more information. The recipient’s records must include documentation of the nature of the emergency. Emergency services are exempt from copayment. When a child experiences a traumatic loss of teeth, removable prostheses may be provided by backdating a PA request. Refer to the MA handbook for more information. CAN DENTISTS WHO ARE NOT MA-CERTIFIED TREAT A PATIENT ON AN EMERGENCY BASIS AND, IF SO, WHAT IS THE CORRECT PROCEDURE? Yes, a non-certified dentist can treat a patient on a emergency basis. However, effective August 2013 and due to new ACA requirements, all dentists who treat MA patients, even if just on an emergency basis, must be enrolled in as a MA Provider. Dentists who do not wish to take all MA patients into their practice will then have the option of applying for limited MA enrollment as an in-state emergency provider. This limited MA enrollment makes the dentist a MA provider for a single date of service (the date in which the emergency service is provided) ONLY. For treatment of other emergency MA patients, on different days, one would need to re-enroll.

Frequently Asked Practice and Legal Questions

Limited MA enrollment can be done via the ForwardHealth Portal at www.forwardhealth. wi.gov. HOW IS THE PROCEDURE DIFFERENT IF THE PATIENT IS SEEN BY A MACERTIFIED DENTIST? The office should file a claim with MA and get paid MA rates for the immediate care without having to retain the patient beyond the initial emergency appointment. A MA-certified dentist CANNOT see a MA patient on a cash basis. However, a non-MA certified dentist CAN see a MA patient on a cash basis. WHERE CAN MA-CERTIFIED DENTISTS REFER MA PATIENTS IF THEY ARE UNABLE TO TREAT THEM? A MA-certified dentist can direct an individual to the ForwardHealth Member Services at 800-362-3002. ForwardHealth is the fiscal agent with whom the State of Wisconsin contracts for the administration and claims payment for the MA programs. Representatives are available Monday through Saturday, 7 a.m. to 9 p.m. and will assist patients who are currently covered under MA. They are equipped with listings of dental practices that serve the MA population and are mailed to the recipient upon request. If a MA patient wants to voice his/her concerns about the inability to find dental care, please encourage them to contact their own state legislators.

OF TIME THEY ARE NOT MA-CERTIFIED? CAN THE DENTIST REQUIRE THE PATIENT TO PAY THE DENTIST’S FULL FEE? Yes, a dentist who is not MA-certified can treat any MA patient and charge the patient the dentist’s normal fee. To limit confusion or miscommunication, it is suggested a treatment plan, along with payment arrangements (which also should clearly state that MA will not be billed), be signed prior to any treatment being performed so patients clearly know their financial obligations in advance. However, this does NOT apply for dentists who are MA-certified providers, but not accepting new MA patients. The contract the dentist signs as a MA-certified provider prohibit him/her from picking and choosing which MA patients will be paid for by MA and which will pay out-of-pocket. This state contract requires a certified dentist to treat any MA patient through the MA program. This includes accepting MA as payment in full and prohibiting balance billing the patient the remainder of the fee and/or accepting cash payment for MA-covered procedures. In summary, this provision does not require MA-certified providers to see all MA patients who request to be seen, but it does require that once they agree to treat an MA patient, they do so through the MA program (and not as a cash patient). IF A DENTIST IS MA-CERTIFIED AND THE PATIENT NEEDS A PANORAMIC X-RAY THAT IS NOT COVERED BY MA, CAN THE DENTIST BILL THE PATIENT FOR THE X-RAY IF THE PATIENT STILL WANTS IT DONE? If the dentist is certain MA does not cover the service needed and informs the patient up front, then it is acceptable to bill the MA recipient for non-covered services. It is recommended patients sign a financial waiver prior to receiving the service(s) to confirm they understand their financial obligations. IF A MA-CERTIFIED DENTIST HAS AN ESTABLISHED PATIENT WITH COMMERCIAL INSURANCE WHO NOW PRESENTS WITH MA AS SECONDARY INSURANCE, AND THE OFFICE IS NOT ACCEPTING NEW MA PATIENTS, CAN THE PATIENT BE BILLED THE SECONDARY PORTION RATHER THAN BILLING MA? No, the MA-certified provider cannot choose to accept payment from a commercial insurance and then bill the patient (rather than the MA program) the balance. If the services are provided by a MA-certified dentist, the MA program must be billed as secondary insurance, prohibiting the dentist from billing the patient for the balance. CAN I FORGIVE CO-PAYMENTS FOR PATIENTS COVERED BY DENTAL INSURANCE OR GOVERNMENT PROGRAMS LIKE MEDICAID AND MEDICARE? No, the forgiveness of co-payments may subject a dentist to sanctions by the Wisconsin Dentistry Examining Board pursuant to section 447.07(3)(k) of the state Statute. Under section 447.07(3)(k), the DEB may reprimand or suspend the license of a dentist who has participated in “repeated irregularities in billing a third party.” Subsections (3)(k)(1)-(5) enumerate the specific actions that constitute “repeated irregularities in billing a third party.”

I AM NOT A MA-CERTIFIED PROVIDER BUT STILL SEE MA PATIENTS ON A CASH OR EMERGENCY BASIS. WHEN I TREATED A MA PATIENT AND WROTE THEM A PRESCRIPTION, THE PHARMACY WOULDN’T FILL IT STATING THEY CAN’T SINCE I AM NOT MA-CERTIFIED. NOW WHY AM I TOLD I NEED TO BE A MA PROVIDER TO WRITE PRESCRIPTIONS TO MEDICAID PATIENTS?

This subsection authorizes sanctions for dentists that engaged in repeated irregularities in billing a third-party for services rendered to a patient.

There are new Medicaid Prescriber Requirements passed down to states to implement due to the ACA.

2. Reporting incorrect treatment dates for the purpose of obtaining payment.

Medicaid/BadgerCare Plus now requires all professionals (not just dentists) who prescribe, refer, or order services for Medicaid/BC+ members on and after July 15, 2013, to be enrolled as either a full Medicaid provider or as a prescribing/referring/ordering provider (PRO-Provider). PRO provider enrollment is NOT full Medicaid enrollment. PRO providers cannot bill Medicaid/BC+ and are not listed in the Medicaid/BC+ provider directory.

4. Incorrectly reporting services rendered for the purpose of obtaining payment.

In this paragraph, “irregularities in billing” include: 1. Reporting charges for the purpose of obtaining a total payment in excess of that usually received for the services rendered. 3. Reporting charges for services not rendered. 5. Abrogating the co-payment provisions of a contract by agreeing to forgive any or the patient’s entire obligation for payment under the contract.

Enrollment as a PRO provider will ensure Medicaid-covered patients in limited benefit plans can fill Medicaid-covered prescriptions with their ForwardHealth cards if the dentist is not currently a participating Medicaid provider.

The forgiveness of co-payments, referred to in the statute as abrogating the copayment, is considered a billing irregularity in the context of billing third parties for services because the claim submitted to the third-party (generally an insurer) shows one amount as the charge, while forgiveness of the co-payment results in the actual charge being lower.

PRO enrollment is free; providers only need to enroll once. Please go to the ForwardHealth Portal at www.forwardhealth.wi.gov and select Become a Provider on the left to begin enrollment. Enrollment response is typically within 10 days.

For example, if the charge to an insurer shows $1,200 with $200 of that amount being co-payment, an insurer paying at approximately 83 percent of normal charges would pay you $1,000 (leaving $200 for the patient).

For more information, please see the ForwardHealth Update on PRO at: www.forwardhealth. wi.gov/kw/pdf/2013-34.pdf.

However, if you were to forgive the $200, your actual charge for the service would be only $1,000 – meaning the insurer should be paying only $830.30.

ARE DENTISTS WHO ARE NOT MA-CERTIFIED PROVIDERS STILL ALLOWED TO SEE MA PATIENTS PROVIDING THEY INFORM THE PATIENT AHEAD

In addition, both Medicare and MA programs also contain restrictions on your ability to waive beneficiary’s obligations for co-payments.

2014 WDA Sourcebook

Frequently Asked Practice and Legal Questions While the statute refers to repeated irregularities in billing, there is nothing to suggest how many times a dentist might be able to forgive a co-payment without being at risk. That being said, the conservative approach would be to avoid forgiving co-payments and certainly not to have a written or articulated a policy of doing so, even in limited circumstances. Taking a conservative approach is further warranted by the fact that the prohibition against abrogation of co-payments is specifically repeated at DE 5.03 of the Wisconsin Administrative The WAC version is written as an absolute without repetition of the statute’s “repeated irregularities” reference.

While the provision of free examinations could arguably average your charge for dental exams to below your “usual” charge, the practice would seem to be an unlikely target since no insurer is being billed for the free services. Since whitening services are generally viewed as cosmetic and not covered by insurance in any event, the “averaging” argument (i.e., averaging to reach the usual rate for insurance coverage) is inapplicable. It also seems that a supportable argument can be made for keeping “free” examination services outside of your normal charge calculation on the basis that it is a promotional offer and that you apply your “normal” charges to all ongoing patient procedures.

Arguably yes. While offering discounts is not explicitly prohibited, discounting can raise a number of unintended and/or unexpected issues.

• A dentist who does not have a contract to provide care for the state’s MA program, but who may or may not be under contract with an insurance company, charges a MA patient for services not covered by MA at what he or she knows to be an insurance company rate even though it is less than the full price generally charged to uninsured patients.

As noted above, the discount cannot be given in a manner that results in the forgiveness of a co-payment. Forgiveness of co-payments is prohibited by Section 447.07(3)(k) of the state Statute.

By charging the MA patient a lower rate, the patient is receiving a discount on the dental service. If this occurs frequently, the impact of charging a lower rate rather than full price may average down the overall cost of the procedure and lower the “usual” rate of the procedure.

Additionally, both the Medicare and Medicaid programs restrict the ability to waive copayments.

It again seems to be an unlikely target for complaint, since no insurer is being charged and the numbers of instances are likely to be relatively small in relation to the overall number of like procedures performed at your usual rate.

IF I CANNOT FORGIVE CO-PAYMENTS, CAN I EVER OFFER DISCOUNTS?

As a practical matter, it may make little sense to provide discounts to patients covered by insurance. Assume a patient has 20 percent co-pay coverage and you provide $5,000 in services with a $1,000 discount. Only $4,000 may be shown on your claim to the insurance company, otherwise, your patient still pays a 20 percent, or $800 co-pay (which you cannot forgive), and the insurance company pays $3,200.

You decide to provide the same discount described above, but make it available only to your uninsured patients. The result here is not entirely clear; however, Wisconsin Statute sections 447.07(3)(i) and (k)(1) prohibit obtaining compensation by deceit or by reporting charges for the purpose of obtaining a total payment in excess of that usually received for the services rendered. Making a discount available to all (or a substantial number of) uninsured patients might be seen as indicating (or could at least be argued by an insurer to indicate) that the discounted fee is your “usual” rate and that you are reporting a different, higher, charge to the insurer in order to receive payments in excess of your usual charges. Offering frequent discounts to a number of patients for particular procedures without regard to their insurance status may have the effect of averaging down your “usual” rate for those procedures. By providing discounted services, your “usual” rate would no longer be the higher, undiscounted, amount and could instead become a blend of the discounted and undiscounted charges. For example, if a routine exam costs $100, you perform 10 per week but provide two of those exams for $50, and then the usual rate becomes a blend of the eight $100 exams and the two $50 exams or $90 rather than $100. The typical rate for the routine exam will no longer be the “usual” rate ($100) because “usual” now represents a combination of the $100 and $50 exams. Failing to report the combination rate to an insurer may present the same concern discussed above, since billing insurers in excess of the usual amount could be argued to constitute a billing irregularity. While there are no hard and fast answers, and while avoiding discounts is the safest course, we believe that from a practical standpoint occasional discounts, or even free services in a limited promotional context, are unlikely to present issues unless they are prevalent enough to lead to legitimate questions as to the amount you bill to insurers as your “usual” charge for particular procedures. Unfortunately, there is no guidance in either the statute or the WAC as to the number of discounted procedures or free services that can be provided without being at risk. As noted, the most conservative approach is to avoid engaging in such practices. Still, a number of dentists have asked about discounting or providing free services in specific situations: • Offering a patient a certificate for future discounts on dental services. When a discount is made available to a significant number of patients, the usual cost for the procedure will arguably be averaged down. By failing to report a rate that reflects both discounted and undiscounted procedures, an insurer may argue that you are reporting a different, higher, charge to receive payments in excess of your usual charges. If you offer future discounts on any type of regular basis, we believe that would need to be reflected in your “normal” rate. • You offer a free exam or free whitening services to every new patient. On its face, providing free dental exams or free whitening services to new patients does not impact third-party billing because you bear the entire cost of the procedure.

Again, occasional discounting would be permissible, so long as it does not take the form of forgiveness of co-pays and you do not apply it in a manner that might raise questions about the propriety of your charges to insurers or the amount of your “usual” charge for any given procedure. While it does not go to the question of whether you may offer discounts, you should also note that if you offer a discount for payment in cash, while allowing patients who pay at an undiscounted rate to stretch their payments over time, the amount of discount may need to be disclosed as interest that is being paid by those patients not receiving the discount. This would bring both Federal Truth-In-Lending and Wisconsin Consumer Act provisions into play. TIL and WCA issues are addressed separately in an article available from the WDA’s Legislative Office. Call 888-538-8932 for more information. CAN I PROVIDE GIFT CERTIFICATES TO PATIENTS THAT REFER NEW PATIENTS TO MY OFFICE? You can provide current patients with gift certificates to retail establishments, but discounting issues would again arise if patients receive gift certificates for dental services. As long as the gift certificates are for non-dental services, we do not believe they should be treated as a billing irregularity under subsection 447.07(3)(k). Although whitening is a dental service, it is (as noted above) distinguishable from other services because it is treated as cosmetic and generally not covered by insurance.

Frequently Asked Practice and Legal Questions

Your $1,000 discount will have cost you the full $1,000, saved your patient only $200 and saved the insurance company the other $800.

That conclusion would change, however, if a significant number of procedures were performed on such a basis.

Since it is not covered by insurance, there is no concern that providing free whitening services could “average down” your normal charge for insurance reimbursement purposes. Thus, gift certificates for free whitening services would seem to fit within the same category as gift certificates to retail establishments and are unlikely to present an issue. An arrangement in which current patients receive gift certificates for dental services (other than whitening) for referring new patients may lead to the same discounting problems discussed above (i.e., billing insurers in excess of your “usual” rate). If a large number of current patients refer new patients to your office, resulting in reductions in charges for specific services, the question would again be whether such reductions occur frequently enough that your normal cost for a procedure would be averaged down. As a result, the conservative approach would be to avoid implementing a referral policy that provides gift certificates for free dental services (other than whitening). Of course, the use of gift certificates to cover a patient’s co-pay would be prohibited as simply an attempt to avoid the prohibition against the abrogation of co-pays. CAN I PROVIDE CITY CHAMBER DOLLARS AS A “THANK YOU” FOR A REFFERAL TO MY DENTAL OFFICE WITHOUT BEING IN VIOLATION OF ANY STATE STATUTES? As we understand chamber of commerce dollars, they are essentially equivalent to checks or gift cards which can be cashed and used as payment by the holder at any local business that is a member of the chamber and in good standing. Chamber members can purchase the chamber Dollars and then provide them to individuals as gifts or offer them as a form of incentive to employees or customers. Once the chamber dollars are issued to the patient, they may be redeemed at any qualifying city business, including a dental practice. 2014 WDA Sourcebook

Frequently Asked Practice and Legal Questions There is no requirement chamber dollars must be applied to the patient’s dental account or used in exchange for dental services.

The HIPAA compliant format will become the only nationwide compliant format used by health care professionals choosing to submit electronic claims to insurers and clearinghouses.

The concern is whether or not an uninsured patient can cash/redeem chamber dollars from the dental practice to pay for services, or to cover copayments for insured patients as use might violate Section 447.07(k) of the Wisconsin Statutes.

This single format will ultimately enable all insurers and clearinghouses to accept electronic claims and will eliminate the problems associated with multiple formats.

The WDA does not believe the use of chamber dollars creates an issue in this regard. There are two primary distinguishing features between the chamber dollars and the use of “copayment abrogation” and/or “discounts” as discussed in the WDA Sourcebook. The initial distinction is the ability of the patient to use the chamber dollars at a variety of other businesses. By their nature, the financial benefit received by a patient as the result of co-payment abrogation and/or discounts is specific to the dental practice involved.

WHAT BASIC STEPS CAN DENTAL OFFICES TAKE TOWARD COMPLIANCE WITHELECTRONIC TRANSACTIONS AND CODE SETS? Since October 2002, all dental offices that electronically submit protected health information were required to use a HIPAA compliant format. The Centers for Medicare and Medicaid Services oversee complaints relating to the electronic transactions and code sets rule.

The second distinguishing factor is that the chamber dollars are awarded for a patient referral and are not directly related to any specific dental procedure. Since they are not procedurerelated, the chamber dollars do not affect the amount billed for any particular service and thus do not result in the type of “billing irregularities” covered by the statute.

The HIPAA complaint format should be available through current software packages.

For example we might well reach a different result if a specific reward were tied to a particular procedure or service, dependent on reaching a specified overall level of charges for dental services or required to be used at the specific dental practice.

Frequently Asked Practice and Legal Questions

All outdated, deleted and revised codes in older ADA CDT manuals should not be used for electronic claims submissions and offices will receive denials if submission continues. A new ADA CDT manual is produced yearly and should be obtained through the ADA.

Since the patient can use the chamber dollars elsewhere, they are not specific to the dental practice or the services provided and thus have no direct effect on the amount the patient or the insurer is obligated to pay for dental services.

While we are confident in our conclusion based on the facts presented, the WDA cautions chamber dollars or similar gifts/incentives could present an issue if used differently.

As long as the chamber dollars are not used in this way; it is not seen as violating any state statutes 7. HIPAA WHAT IS THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT? The Health Insurance and Portability and Accountability Act was signed into law in 1996 and it has multiple initiatives that affect providers, insurers, employers, patients and other covered entities. As of December 2002, only the “administrative simplification portion” of the HIPAA regulations applies to dentistry. There are two sections within the administrative simplification portion. They are the Security rule (electronic transactions and code sets) and the Privacy rule. ARE ALL DENTAL OFFICES COVERED UNDER HIPAA? Technically, only dental offices that submit protected health information electronically are covered under HIPAA. These offices (electronic filers) must comply with both the security and the privacy rules. However, the ADA and WDA strongly advise all dental offices, including those that file by paper, to comply with the HIPAA privacy rule. The compliance deadline for this rule was April 14, 2003.

Please check with your software vendor to confirm that your office is compliant. For more information, visit the CMS website at www.cms.hhs.gov. Contact the ADA at 800-621-8099 to order the CDT 2014 or visit www.ada.org for more information. WHAT IS THE PRIVACY RULE AND WHAT STEPS CAN DENTAL OFFICES TAKE TOWARD COMPLIANCE? The rule’s underlying objective is to protect patient privacy and ensure health information is not misused. While most dental offices have some type of privacy policy in place, this federal rule is designed to be both uniform and comprehensive. It standardizes policies on patient privacy, addresses business associate contracts, clarifies appropriate oral communications and informs patients of the safeguards in place to protect their privacy. Effective September 23, 2013 The U.S. Department of Health and Human Services strengthened the privacy and security protections previously set in 1996. These changes provide the public with increased protection and control of person health information. The new regulations set forth: • Enhanced HIPAA enforcement; • Expanded HIPAA requirements to business associates (BAs) who receive protected health information; • Expanded patient’s rights to receive electronic copies of their health information and restrict disclosures to health plans regarding treatment for which the patient paid the provider out of pocket and in full; • Required modifications, and redistribution of, Notice of Privacy Practices; • Modified rules applying to marketing and fundraising communications and the sale of protected health information, allowing patients to “opt out”; • Expanded definition of “health information” to include genetic information; • Clarified when data breaches MUST be reported to HHS Office for Civil Rights.

The ADA believes the privacy rule will either change to encompass all dental offices or become the standard of care.

Modified HIPAA Privacy forms and additional information can be obtained by contacting The Dental Record at 800-243-4675 or www.dentalrecord.com.

In either case, all dental offices should be prepared by having privacy requirements in place.

Additional questions may be addressed at the WDA Legislative office at 888-538-5932 or evaladez@wda.org.

WHAT IS THE BEST WAY TO STAY CURRENT WITH HIPAA AS IT CHANGES? Members can stay informed via the ADA and WDA monthly publications and websites. Both tools offer concise, dental-specific guidance and up-to-date information. Additional HIPAA information can be found on: • www.ada.org/goto/hipaa • www.wda.org • www.hipaacow.org (HIPAA Collaborative of Wisconsin website) • www.hipaa.com • www.hhs.gov/ocr/privacy WHAT DOES THE ELECTRONIC TRANSACTIONS AND CODE SETSRULE REQUIRE? Under HIPAA, all dental offices that submit protected health care information electronically must utilize both the HIPAA compliant format and the most recent dental treatment codes.

The ADA CDT 2014 is the only set of dental codes that insurers will accept electronically via the nationwide HIPAA format.

2014 WDA Sourcebook

The following are basic steps dental offices should take toward compliance with the privacy rule: 1. Name someone on your staff to serve as Privacy Officer. 2. Keep current on HIPAA through the ADA and WDA communications and other online sources listed previously 3. Have your Privacy Officer conduct a “gap analysis” by viewing the office as a patient (e.g., walk around patient-access areas, identify all possible points where patients may view health information and identify areas where changes are necessary to protect patient information). The gap analysis should be documented and kept on file. 4. Purchase the ADA’s HIPAA Compliance Manual and develop a office policy based-on federal privacy requirements, state privacy laws, gap analysis findings and sample HIPAA forms. ARE THERE AREAS OF PATIENT PRIVACY WHERE STATE LAWS ARE STRICTER THAN THE FEDERAL HIPAA PRIVACY RULE? There are certain Wisconsin patient privacy laws that are stricter than sections of the federal privacy laws. Areas where Wisconsin privacy law is more stringent than HIPAA pertain to consent:

Frequently Asked Practice and Legal Questions • Wisconsin allows disclosure of PHI without written consent of the patient for reasons that fall within the scope of treatment, payment or health care operations (TPO Guidelines), although it must be documented by the dental office. • State law requires written consent to discuss or disclose confidential medical/dental information to family members or other persons involved with care of the patient and authorized person must be listed on the consent form. • Providers are required to document each time a patient or a patient’s personal representative comes to inspect medical/dental records. For more information, contact the WDA Legislative Office at 888-538-8932. WHAT IS THE SECURITY RULE AND WHAT STEPS CAN DENTAL OFFICES TAKE TOWARD COMPLIANCE? The purpose of the HIPAA Security Rule is to protect the confidentiality, integrity and availability of electronically submitted protected health information whereas the HIPAA Privacy Rule applies to all patient information whether oral, written or electronic. Covered entities (those who submit protected health information electronically) were to comply with Security Rule requirements by April 21, 2005, and the currently enhanced rules that went into effect September 2013. Again, it is recommended that all dental offices (even those that aren’t technically covered by this rule) review their current office policies and implement administrative safeguards that ensure they protect the confidentiality and integrity of their patients’ protected health information.

The covered entity/provider is the one required to report the breach of unsecured PHI, even if it occurred through an employee, independent contractor or a business associate. The persons affected by the breach, along with HHS must be notified of what happened, the type of unsecured PHI that was involved, steps taken to protect individuals from harm, what actions are being taken and contact information for further questioning. Notice to affected individuals is required via first class mail while breaches involving 500 or more residents of a particular area require notification through prominent media outlets (press releases). It is also required for covered entities to maintain a log of all breaches and submit that to HHS annually. Covered entities must develop policies and procedures to the Breach Notification Rule and also make sure all staff is aware of and is in compliance with this rule. The ADA created “Guidance for Complying with the HIPAA/HITECH Breach Notification Rule” to help offices implement these rules into their practice and can be downloaded via their website at www.ada.org. For more detailed information on HIPAA, the ADA also offers a Practical Guide to HIPAA Compliance and can be ordered via the ADA Catalog (J594) or by calling 800-947-4746. AN UNHAPPY PATIENT HAS MADE THREATS TO BOTH THE DENTIST AND STAFF. THE STAFF FEEL THEIR SAFETY IS COMPROMISED AND FEAR HIS/HER RETURN TO THE OFFICE. IS IT A HIPAA VIOLATION TO REPORT THIS PATIENT’S THREATENING BEHAVIOR TO LAW ENFORCEMENT AUTHORITIES?

• Appoint a Security Officer; this person may also be the Privacy Officer, contact person and/or the dentist.

The rule permits covered entities to disclose protected health information to law enforcement officials, without written authorization from the patient for specific circumstances.

• Implement administrative safeguards, such as security policies and procedures.

Disclosures should be limited to:

• Use physical safeguards, such as locking doors when no one is in the office.

• Encrypt all electronic communications with PHI that are done via email

• Preventing or lessening a serious and imminent threat to the health or safety or an individual or the public (The determination of whether a patient’s statements or behavior constitute a serious and imminent threat to another person should be made pursuant to an objective assessment of the patient’s actions, taking into account any knowledge of past behavior or other circumstances surrounding the threat).

WHAT NEEDS TO BE DONE WITH REGARDS TO THE HIPAA/HITECH BREACH NOTIFICATION RULE?

• Reporting PHI that the covered entity in good faith believes to be evidence of a crime that occurred on the covered entities premises

In 2009, the American Recovery and Reinvestment Act put forth rules pertaining to breaches in security to your patients’ protected health information. In 2013 HHS strengthened this act by clarifying when to report breaches and also increased monetary penalties based on negligence of the breach.

• Identifying a person who appears to have escaped from lawful custody and/or to a correctional institute or law enforcement official having lawful custody

• Identify and use technical safeguards, such as password protections and backups of patient records.

If a patient’s PHI is acquired, accessed, used or disclosed by any unauthorized persons these rules detail who the covered entity/provider must notify of the breach and the timeframe involved based on the number of patients effected. A dental practice is a covered entity if it transmits any health information electronically and must follow the HIPAA Security Rule and the HIPAA Privacy Rule and any amendments to those rules set forth. Dental practices must implement policies and procedures to comply with this rule.

• Authorizing federal officials to conduct intelligence, counterintelligence and other national security activities • Complying with a court order or court-ordered warrant, a subpoena or summons issued by a judicial officer or a grand jury subpoena • Responding to an administrative request such as an administrative subpoena or investigative demand from a law enforcement official

• Is notification of the breach required?

• Requesting PHI to identify or locate a suspect, fugitive, material witness or missing person but should be limited to name and address, date and place of birth, Social Security number, ABO blood type and Rh factor, type of injury, date and time of treatment, date and time of death, and a description of distinguishing physical characteristics

• What is the timeframe in which the dental office must provide the notification?

• Identifying a person who has admitted participation in a violent crime

• Who needs to provide the notification?

• Responding to requested PHI about a victim of a crime, and the victim agrees

• What channels of notification are required based on the number of patients effected?

• Reporting child abuse or neglect

• What information is required to be included in the notification?

• Addressing adult (elder) abuse, neglect or domestic violence; if the victim agrees

• Who receives this notification?

• Reporting when required by law (i.e., incidents of gunshots, stab wounds or other violent injuries)

Some basic questions to ask if one discovers a possible breach include:

• How should I provide the notification? If a breach is suspected, an office must first determine if the PHI was secured or unsecured. Secured PHI does not required notification while unsecured PHI does. Secured PHI is considered unusable, unreadable or indecipherable to any unauthorized persons such as encrypted emails or electronic exchanges of PHI that require a password or key to read, while all other PHI is considered unsecured. A risk assessment can determine if the breach violated the HIPAA Privacy Rule by being disclosed in a way that is not permitted. Reasonable time is permitted to gather information; but a provider must report a breach in PHI no later than 60 calendar days after the breach was discovered.

Frequently Asked Practice and Legal Questions

Dental offices should take the following basic steps toward compliance with the security rule:

In general, HIPAA Privacy does not prohibit a covered health care provider from sharing protected health information in order to report a crime which transpired on the provider’s own premises.

• Alerting law enforcement to the death of an individual when suspected the death was a result from criminal conduct • Responding to an off-site medical emergency, to alert law enforcement about criminal activity. The Privacy Rule is balanced to protect an individual’s privacy while allowing law enforcement functions to continue. Any disclosures made by a dental office under the authority of these exceptions should be kept to a minimum and should only be released to identify authorities.

2014 WDA Sourcebook

Frequently Asked Practice and Legal Questions 8. INSURANCE AND COORDINATION OF BENEFITS WHO REGULATES DENTAL INSURERS TO MAKE CERTAIN THE DATABASES THEY MAINTAIN ARE COMPLIANT WITH WISCONSIN LAWS? The Wisconsin Office of the Commissioner of Insurance regulates dental benefit plans. If a patient were to lodge a complaint, OCI would investigate the case and report back to the patient within an allotted time frame. However, prior to contacting OCI, patients should first correspond directly with the dental benefit plan. Only after exhausting the plan’s internal grievance process will OCI take action. In addition to complaint-driven inquiries, OCI also implements market conduct examinations that periodically review insurer business practices. HOW DO I FILE AN INSURANCE COMPLAINT? The OCI assists complainants with their insurance problems. Insurance complaints can be filed by accessing the OCI complaint form found on the website below. Complete this form and submit to OCI via fax or mail, both found below. WHAT ARE OCI COMPLAINT PROCESSING GUIDELINES and WHERE CAN I OBTAIN A COMPLAINT FORM? OCI complaints and their processing guidelines can be found online at http://oci.wi.gov/ com_form.htm.

Frequently Asked Practice and Legal Questions

HOW DO I REPORT PATIENT INSURANCE FRUAD? Report any type of patient fraud involving insurance to the National Insurance Crime Bureau at 800-835-6422.

Where both coordinating plans follow the birthday rule, the order of benefits is as follows: • Employee/dependent – The plan covering that person as an employee pays benefits first. The plan covering that person as a dependent pays benefits second. • Dependent child of parents not separated or divorced – The plan covering the parent whose birthday falls earlier in the year pays first. The plan covering the parent whose birthday falls later in the year pays second. A person’s year of birth is not relevant in applying this rule. • Court decree – If the specific terms of a court decree, states one of the parents is responsible for the child’s health care expenses and the insurer or other entity obliged to pay or provide the benefits of that parent’s plan has actual knowledge of those terms, the plan pays first. If any benefits are actually paid or provided before that entity has actual knowledge, this court decree rule is not applicable during the remainder of the plan or policy year. • Dependent children of separated or divorced parents – When parents are separated or divorced, neither the male/female rule nor the birthday rule applies. Instead, the plan of the parent with custody pays first, the plan of the spouse of the parent with custody (stepparent) pays next and the plan of the parent without custody pays last. For more information, see the children of divorced parents FAQ section. • Active/inactive employee – The plan covering a person as an employee who is neither laid off nor retired or as that person’s dependent pays benefits first. The plan covering that person as a laid off or retired employee (or as that person’s dependent) pays benefits second. If both plans do not have this rule and if, as a result, the plans do not agree on the order of benefits, this rule is ignored. This fallback provision prevents both plans from being secondary.

This includes fraudulent names, information, cashing insurance checks with no payment to the dental provider.

• Longer/shorter length of coverage – If none of the above rules determine the order of benefits, the plan covering a person longer pays first. The plan covering that person for the shorter time pays second.

The National Insurance Crime Bureau is a federal bureau offered to protect insurers from fraud and abuse. The bureau will contact the insurer and investigate the case to resolve the problem.

COB should happen between carriers.

HOW DO I OBTAIN LEGAL ASSISTANCE IN REVIEWING A POTENTIAL INSURANCE CONTRACT? Through your membership with the ADA and the WDA you are offered the ADA legal analysis of any insurance contract through the WDA prior to joining as a contracted provider. This analysis defines certain critical terms in contracts, and provides questions for dentists to ask before entering into a contract. This analysis is offered in no way to influence dentists from whether or not to join a network, rather it is provided by request solely as an informational tool to assist members. In addition this service is not offered for those dentists who are already signed onto a network and would like to have that signed contract reviewed. They also do not provide analysis of state dental plans (Medicaid). Contact Erika Valadez at evaladez@wda.org or 888-538-8932 for more information. This service is only offered as a benefit through the WDA membership. Non-member requests and requests directly to the ADA will not be fulfilled. HOW DOES COORDINATION OF BENEFITS WORK? Coordination of benefits in an orderly system is intended to establish uniformity and consistency in the order in which claims are paid when a person is covered by two or more dental benefit plans. This provision allows payment up to, but not to exceed, 100 percent of the total fee. Male/female rule – Up until January 1987, the male/female rule was in effect. The father’s plan was primary for him and the children and was secondary for his spouse. The mother’s plan was primary for herself. The father’s plan would be secondary. Birthday rule – The birthday rule went into effect January 1987 (the spouse with the birthday occurring earlier in the calendar year is primary). However, if one coordinating plan uses the birthday rule and the other uses the male/female rule, both plans will follow the male/female rule. The primary plan always pays the same benefits it would pay in the absence of any duplicate coverage; it never pays more and it never pays less. There can be more than one primary plan in which case both pay benefits without taking into consideration benefits paid by the other plan. Any plan not primary is considered secondary. The secondary plan pays the difference between some maximum amount of the primary plan, but never more than the total expenses actually incurred. According to some plans in effect, the plan interprets the law to mean the secondary plan never pays more than it would have had it been primary. HOW DO YOU DETERMINE PRIMARY AND SECONDARY COVERAGE?

The primary and secondary dental benefit plans are determined by the birthday rule.

2014 WDA Sourcebook

AS A SECONDARY CARRIER, DO ALL PLANS COORDINATE BENEFITS THE SAME WAY? No. Wis. Adm. Code INS 3.40, permits insurers to coordinate benefits at three levels or options. One level/option is the full coverage level to which you are accustomed. It coordinates up to 100 percent of the allowable expense. The secondary plan pays the difference between what the primary plan pays and the charge, thus giving full coverage of the cost. The second level/option requires that benefits be coordinated up to 80 percent of the cost. Under this option, if the primary plan paid $50 of a $100 charge, according to their benefit structure, then the secondary plan would pay $30 so it equals 80 percent of the cost. The third level/option permits insurers to limit their coverage to benefits which would have been paid had there been no other insurance (ie: a secondary plan being available). HOW DO INSURERS DETERMINE UCR? Dental benefit plans that utilize the term UCR are required to maintain a database containing provider fees for designated towns, areas and/or zip codes. This geographic specific data is utilized to determine a plan’s UCR. Under Wisconsin law, an insurer’s UCR database must meet the following conditions: • The fees contained in the database should reflect the actual amounts charged by the providers and NOT the amount paid through discounted fees, preferred provider organizations and/or Medicare • The database shall be updated at least once every six months • At the time of an update, no data in the database may be older than 18 months • To ensure charges are as accurate as possible for the geographic area, the database should be capable of sorting or compiling data based on CDT codes and zip codes/region WHAT ARE INSURERS REQUIRED TO PROVIDE TO THE PATIENT WHEN THEY ARE COVERED UNDER A DENTAL PLAN? The insurer must provide all of the following information/resources to policyholders (patients) including: • Payment methodology used by the insurer to determine the amount the insurer will pay for specific procedures covered by the plan. • If applicable, an explanation of why insurance payments might be less than the provider’s charge for the dental service, thereby informing the patient he/she may be responsible for the balance of the bill.

Frequently Asked Practice and Legal Questions • Some insurers include a provision that attempts to prevent the policyholder (patient) from having to pay the difference between the dentist’s actual charge and the insurance payment. If a patient signs an agreement to pay an out-of-network provider the difference between the fee and the insurance payment, the agreement has precedence over the insurance provision. • The insurer must provide the patient with the telephone number of a contact person and/ or section within the company that can provide further information about the claims payment process. This contact information should be included with the patient’s EOB information. • In cases where the insurance payment is less than the provider’s billed amount, the insurer must also provide reasonably specific details to the patient on the EOB including the appropriate CDT code(s) used to record dental treatment procedures. WHAT IS A SAMPLE LETTER DENTISTS OR PATIENTS COULD USE WHEN REQUESTING INFORMATION FROM THE THIRD PARTY PAYER TO EXPLAIN WHY A CLAIM WAS PAID AT A RATE LESS THAN THE ACTUAL CHARGE?

payment was placed in the U.S. mail in a properly addressed, postpaid envelope, or, if not so posted, on the date of delivery. All overdue payments shall bear simple interest at the rate of 12 percent per year. (2) Notwithstanding sub.(1), the payment of a claim shall not be overdue until 30 days after the insurer receives the proof of loss required under the policy or equivalent evidence of such loss. The payment of a claim shall not be overdue during any period in which the insurer is unable to pay such claim because there is no recipient who is legally able to give a valid release for such payment, or in which the insurer is unable to determine who is entitled to receive such payment, if the insurer has promptly notified the claimant of such inability and has offered in good faith to promptly pay said claim upon determination of who is entitled to receive such payment. (3) This section applies only to the classes of claims enumerated in s.646.31 (2).

A sample letter follows.

9. LICENSING AND CONTINUING EDUCATION

According to a ruling by the Wisconsin Commissioner of Insurance, the potential purchaser of the dental plan, the insured and the provider may request this information. You will have to ask your patient to forward the response they obtain from a third party to you. Because patients do not have access to dental codes, we recommend you provide the appropriate codes for the specific procedures for which they request information.

WHAT LICENSES DO I NEED TO PRACTICE IN WISCONSIN?

Address letter to insurance company, claims administrator or third party payer listed on the explanation of benefits. Dear _________________________: On the attached explanation of benefits, dated ________, your organization denied me full payment of the actual charge submitted by my dentist, Dr. ____________.

A license issued by the DEB is necessary to practice dentistry in Wisconsin. However, there are limited exceptions to this requirement listed in Section 447.03, Wis. Stats. For students in specified training situations, instructors, dental residents at hospitals accredited for dental residency, etc. Verify that an exception applies before relying upon it. Wisconsin Administrative Rule DE 2.03(7) also requires, “the license and certificate of registration shall be displayed in a prominent place by every person licensed and currently registered by the DEB.”

• Method of determining the maximum allowable benefit.

Controlled substances may only be prescribed or dispensed in the course of a dental practice.

• The number of charges collected for that procedure.

For example, a narcotic-based painkiller could be prescribed for a relative who was also a patient and for whom it was warranted as a result of a procedure performed.

Please provide me with the information listed below related to my claim:

• The ZIP code(s) where the charges were collected. • Time frame in which charges were collected.

However, the same medication cannot be prescribed to a relative that was not treated as a patient.

• Highest and lowest charge.

DO I NEED A SEPARATE LICENSE TO PRACTICE A SPECIALTY?

• Percentile of the allowable charge.

While some states issue specialty licenses, no such license is required or available in Wisconsin.

• The date of the last update.

A general dentist may perform services that fall within a defined dental specialty, as long as the general dentist can competently provide that service.

• The percentile upon which payments are made. This information is requested pursuant to Wis. Adm. Code INS 3.60, and necessary to afford me a full and fair review of my claim. Sincerely, Patient name: _____________________ Group number: _____________________ Employee number: __________________________ Cc: Patient may want to send a copy of this letter to the benefits manager at his/her place of employment, the dentist, the WDA. • Enclosure: Explanation of Benefits DO INSURANCE COMPANIES HAVE TO PAY CLAIMS IN A TIMELY MANNER? According to Wisconsin Insurance Statute 628.46 (Timely payment of claims): (1) Unless otherwise provided by law, an insurer shall promptly pay every insurance claim. A claim shall be overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and the amount of the loss. If such written notice is not furnished to the insurer as to the entire claim, any partial amount supported by written notice is overdue if not paid within 30 days after such written notice is furnished to the insurer. Any part or all of the remainder of the claim that is subsequently supported by written notice is overdue if not paid within 30 days after written notice is furnished to the insurer. Any payment shall not be deemed overdue when the insurer has a reasonable proof to establish the insurer is not responsible for the payment, notwithstanding that written notice has been furnished to the insurer. For the purpose of calculating the extent to which any claim is overdue, payment shall be treated as being made on the date a draft or other valid instrument which is equivalent to

While the DEB does not license specialties, they do restrict the ability of dentists to advertise themselves as specialists.

Frequently Asked Practice and Legal Questions

• Dental Code #___________________.

Dentists must register with the DEA to prescribe or dispense any controlled substance (e.g., prescription painkillers) in connection with a practice. A dentist who only prescribes medications which are not controlled substances (e.g., antibiotics) would not have to register with the DEA.

Under DEB Rule DE 6.02, a dentist may advertise as a specialist only upon successful completion of a post-doctorate course approved by the Commission on Dental Accreditation in a specialty recognized by the ADA, including: endodontics, oral and maxillofacial surgery, oral pathology, orthodontics, pedodontics, periodontics, prosthodontics, oral and maxillofacial radiology and public health. DO I NEED TO HAVE A SPECIAL PERMIT TO PROVIDE SEDATION TO PATIENTS IN MY DENTAL PRACTICE? Yes, a special permit is needed to provide sedation to patients. Since July 1, 2007, all dentists providing enteral conscious sedation, parenteral conscious sedation or deep sedation/general anesthesia in their dental practices must obtain a class I (enteral), class II (parenteral) or class III (deep/GA) permit from the DEB. The dentist must apply for the permit by providing of completion of the education and training for the level of permit being sought. No permit is required for anxiolysis or nitrous oxide inhalation but dentists providing any type of sedation services are urged to thoroughly review the rule and ensure current practices comply with state regulations. The code also specifically states any dentist whose patient lapses into conscious sedation (enteral) from the intended state of anxiolysis shall meet the requirements for a class I permit. To review the entire code, please see Chapter DE 11 in the Administrative Rules section. A LAW WAS PASSED IN 2007 REQUIRING DENTISTS TO OBTAIN 30 CREDIT HOURS OF CE TO RECEIVE A RENEWAL LICENSE. THIS REQUIREMENT APPLIES TO THE SEPTEMBER 30, 2015 RENEWAL DEADLINE. ARE THERE REQUIREMENTS FOR THE TYPES OF COURSES THAT MUST BE TAKEN? Yes, there are requirements for types of CE that must be taken for license renewal. Of the 30 hours required, 25 must be in the clinical practice of dentistry or medicine. 2014 WDA Sourcebook

Frequently Asked Practice and Legal Questions

Frequently Asked Practice and Legal Questions The remaining five hours can be in any course relating to the practice of dentistry or medicine. In addition you are required to receive hands-on CPR and AED training A LAW WAS PASSED IN 2006 REQUIRING DENTAL HYGIENISTS TO OBTAIN 12 CREDIT HOURS OF CE TO RECEIVE A RENEWAL LICENSE. THIS REQUIREMENT APPLIES TO THE SEPT. 30, 2015 RENEWAL DEADLINE. ARE THERE REQUIREMENTS FOR THE TYPES OF COURSES THAT MUST BE TAKEN? Yes, there are requirements for types of CE that must be taken for license renewal. Of the 12 credit hours required, dental hygienists must also receive both hands-on CPR training and automated external defibrillator AED training. In addition not less than two of the credit hours required must be satisfied in infection control training. HOW DO I SUBSTANTIATE MY CE HOURS AND HOW LONG SHOULD I KEEP PROOF OF COMPLETION OF CE? You will need to obtain a certificate from the program’s sponsor showing that you attended their program. Certificates of attendance or completion must be kept for a period of six years. The department has the authority to conduct random audits of CE compliance. CAN I COUNT MY TEACHING EXPERIENCE TOWARD CE CREDITS? IF YES, HOW MANY HOURS CAN I COUNT? Up to four hours of teaching experience can be counted in every two-year licensure period. One hour of teaching or preparing a CE program is equivalent to one hour of CE; however a person who teaches or prepares a CE program may obtain credit for the program only once. MUST EMPLOYERS PAY FOR THEIR EMPLOYEE’S CE COURSES? DOES IT MATTER IF THE CE IS REQUIRED AS A CONDITION OF THE EMPLOYEE’S LICENSURE? Dentists and dental hygienists are responsible for their own CE, since requirements are imposed by the state and not the employer. Thus, the purely legal answer is the employer is not required to pay any part of the course registration or related costs. Related considerations include: • Can the employer set the dates on which employees take classes and/or select or require the courses they take? o The employer can refuse to give an employee off for CE in the same way they can refuse any other request for a day off. It would be entirely permissible to use the same procedures for CE as in dealing with any other request for a day off (i.e., it might count as a personal or vacation day and be allowed to the same extent those are, presumably on a basis that does not disrupt patient appointments). o While the employee may have certain course requirements, the employer can certainly make suggestions; however, if the employer elects not to pay for courses or make other supportive arrangements, there is little basis (other than helpful suggestion or persuasion) on which to influence or dictate an employee’s course selection. • The employer does not need to pay wages for time spent in CE that might otherwise have been spent in the office. Neither does the employer need to compensate the employee for time spent traveling to or from CE programs. • The answer to (b) would not change if the employer voluntarily paid for the employee’s CE registration since it is the state that requires attendance. If an employer pays for course registration, payment would be wholly gratuitous and would not trigger any other obligation. • The employer would also not be responsible for travel expenses incurred in connection with CE attendance (e.g., actual travel or mileage, hotel, meals), since this is a requirement imposed by the state. This would not change based on a decision to pay registration costs or even payment for both registration and employee time spent at programs. While the legal answers are clear, they may not represent the best practical approach to dealing (and keeping harmony) with employees. Declining to provide at least minimal CE support will almost certainly reduce the employer’s ability to influence course selection. Possible alternatives include: • Paying registration costs for programs the employer feels are good for the employee. This gives the employer significant control course selection since many individuals are willing to go wherever someone else is willing to pay. Of course, an employee could always decide to select their own programs and pay their own registration and expenses. If you do provide registration fees or other support, you will almost certainly want to limit your assistance to some set number of hours, probably not more than the employee needs to meet the CE requirement in any given educational cycle.

2014 WDA Sourcebook

• Some employers pay travel and related (room and meal) charges, if they think the CE is particularly good and/or beneficial, and there is no comparable program nearby that does not require travel. This can be expensive and the employer may be able to get the course control they prefer by paying registration costs and not travel. If an employee really wants to go to a distant site, but assuming the course itself is one favored by the employer, another solution might be for the employer to pay for registration and for the employee to pay his or her own travel expenses. • If the employer chooses to compensate for time spent at CE (whether payment for time or allowing other time off) is entirely in the employer’s discretion. If you have only one or two employees, you may be able to address issues on a case-by-case basis. However, with more employees, it becomes preferable to have some type of policy to avoid questions of favoritism. For example, you could work with the following options to create a policy: • Select and pay for courses that you believe are beneficial and/or appropriate or do not not pay for CE registration at all • no paid travel or other CE-related (room, meals, etc.) expenses • You may only attend CE: o If course is approved 45 days in advance to permit appropriate scheduling of patient appointments o If we are able to schedule appropriate alternatives for patient appointments on that date o On days you are not scheduled to work o Anything else that fits your particular practice circumstances • If the CE is held during a workday, absence from work for attendance will be treated in accordance with our normal office policy or whatever alternative treatment the employing dentist may decide on. These are only suggestions as to how CE issues might be dealt with and each dental practice should tailor the guidelines to meet their own particular needs and circumstances. 10. EMPLOYMENT LAW AND HUMAN RESOURCES AS THE OWNER OF MY DENTAL PRACTICE/BUSINESS, CAN I CHOOSE TO PROHIBIT THE CARRYING OF CONCEALED WEAPONS ON MY PREMISES? This choice is up to each individual dental practice and we advise each dentist to consult its liability carrier prior to making this decision. 2011 Wisconsin Act 93 relating to the creation of the right to carry concealed weapons in Wisconsin also allows the owners of private businesses to prohibit the carrying of concealed weapons on their premises as long as the prohibition is clearly posted at all entrances of the business. Such posting must be done on signs that are at least 5 inches by 7 inches and are clearly visible to all individuals who enter the business. Should a dental office choose to post these signs, should be posted on bright paper and should include the following language: “In accordance with 2011 Wisconsin Act 93, this private business prohibits the carrying of concealed weapons on its premises.” ARE NOT-TO-COMPETE COVENANTS ENFORCEABLE? Generally, covenants not to compete are enforceable in Wisconsin if they are reasonable in time and scope. Unlike most states where the courts will strike out unreasonable portions of the non-compete restrictions and enforce the rest, in Wisconsin, unless all elements of a non-compete clause are fully enforceable, the entire agreement will be stricken. Whether restrictions are reasonable depends on the facts of each case, although a review of recent Wisconsin court decisions provide at least some general guidelines: • Any restriction seeking to prevent competition for more than two years would be unreasonable. Shorter periods will generally be enforceable. • The restriction cannot prevent the individual from earning a living. Thus a general restriction against practicing dentistry for two years would be invalid. • The restriction cannot be more than what is necessary to protect the employer. For example, if you work in a dental practice located in Milwaukee, a prohibition against practicing anywhere in Wisconsin would be unenforceable. A prohibition against practice in Milwaukee County would most likely be enforceable, while enforceability of a prohibition applicable to Milwaukee, Waukesha and Ozaukee counties would most likely depend on where the practice’s patients are located.

Frequently Asked Practice and Legal Questions

1 While most plan years are on a calendar basis, they may be on any regularly applied 12-month period. Your plan year is whatever 12-month period your plan uses for reporting purposes. 2 For purposes of the example, it does not matter whether $800 is the full cost per employee or whether it is simply the amount you pay (leaving co-pay for employees). It is used only as an example. 3 With respect to health, dental and vision plans, both state and federal law contain provisions requiring that covered employees (and their spouses and dependents) whose coverage terminates as a result of a termination of employment be allowed to continue coverage (at their own cost) for a period of up to 18 months. Federally, the Consolidated Omnibus Budget Reconciliation Act of 1986 applies to employers with 20 or more employees and requires that you permit the opportunity to continue postemployment coverage for up to 18 months. Section 632.897 of the Wisconsin Statutes applies to employers who have less than 20 employees and provide group policy coverage. If your coverage is provided through WDAIP, they will provide a form you can use to provide the applicable continuation option for terminated employees. Wisconsin law does not apply to employers who self-fund their coverage. ARE THERE ANY RESTRICTIONS ON THE HIRING OF MINORS TO WORK IN A DENTAL OFFICE? The legal restrictions applicable to the hiring of minors in the dental office are the same as for the employment of minors in any other work setting. Specifically, Section 103.67, Wis. Stats., requires minors between the ages of 14 and 18 to obtain a work permit before they can be employed.1

Work permits are almost always obtainable at the minor’s school. If not, the Wisconsin Department of Workforce Development can provide the location of an office in your area where you can obtain the work permits. The minor must present the following when applying for a work permit: • Proof of age – birth certificate, baptismal record, driver’s license or state-issued identification card. • A letter from the employer stating the intent to employ the minor along with a description of job duties, hours of work and time of day the minor will be working. • A letter from the minor’s parent, guardian or court-ordered foster parent (while the minor is under their care) consenting to the employment. As an alternative, the parent, guardian or foster parent may countersign the employer’s letter. • Social Security card. • The statutory permit fee of $5. The employer is required to pay the permit fee. • If the minor advances the fee, the employer must reimburse the minor no later than the minor’s first paycheck. • The address of the school the minor attends or name of the school district. You may not permit minors to work during hours they should be attending school (unless they have already graduated). As the employer, you are also required to maintain a copy of the minor’s work permit on your premises. ________________________ 1 Section 103.67(2) (g) contains an exception allowing minors at least 12 years of age or older to work under the direct supervision of their parent or guardian in connection with the parent or guardian’s business, trade or profession. This would allow a dentist’s child to work in the dental office prior to reaching age 14, but does not eliminate the need to obtain a work permit. IF I AM JOINING AN EXISTING PRACTICE, SHOULD I INSIST ON A WRITTEN EMPLOYMENT CONTRACT? There is no legal requirement that you have a written contract and, on occasion, some people view the idea of a contract as unnecessary or even as demonstrating a lack of trust. In addition, it may seem like a lot of work to sit down, think about the things that go into an employment agreement and then put it all down in writing especially when you and your employer are in the “warm glow” of you beginning a new position. Still, if it is hard to do a contract at the start, think how difficult it could be later if issues arise. Thus, while not required, it is recommended you have at least some form of written employment agreement detailing what has been agreed upon. WHAT KINDS OF THINGS SHOULD A WRITTEN EMPLOYMENT CONTRACT COVER? Employment contracts can be very brief or fairly detailed. Generally speaking, they should be long enough to include the major elements of your agreement. Employment contracts generally cover the following: Term of employment, events of termination – Employment contracts are either for a set term or period (e.g., one year, two years) or simply provide you are employed “at will” (meaning employer can terminate you at any time, with or without a reason). Absence of reference to a specific term or time period generally makes the contract “at will.” Normally, a contract will have some form of termination protection so if you are dismissed “without cause” there is some period of advance notice and/or continued pay and/or benefits (e.g., 30, 60, 90 days). Also, where there is a set term, the contract generally renews automatically unless one or the other of the parties gives notice of nonrenewal within some specified period (normally 30 or 60 days) in advance of expiration. There is seldom any employment protection if you are terminated for cause. The contract generally defines what constitutes “cause” by identifying specific events. Examples might be theft, failure to maintain required licenses, failure to perform normal duties, etc. In some cases, where cause is correctible (for example, a failure to keep Saturday hours as opposed to something like theft), a contract may require your employer to provide written notice of the problem and then allow some period of time to correct it (e.g., notice of a failure to keep Saturday office hours, followed by your subsequently being there on Saturdays during the hours in question). Duties – The types of services you are expected to provide should be noted (description can be general or specific, depending on situation), as well as any expectation as to the number of patients to be treated, hours you are to be in the office and any other required duties (e.g., completing dental records, involvement in administration of the practice). If you are responsible for any portion of practice expenses (rent, malpractice coverage premiums, staff salaries, etc.), this also should also be specified.

2014 WDA Sourcebook

Frequently Asked Practice and Legal Questions

A prohibition against you contacting the practice’s patients or those patients you treated while in that practice after leaving would almost certainly be enforceable. Enforcement of other restrictions would depend on what they are, the nature of the particular practice, the location of the practice and its patients and any other relevant factors. Non-compete provisions are frequently included in employment contracts, although they can also be separate, stand alone agreements. If the non-compete provisions are in a separate agreement not entered into at the time of the initial hire, there must be consideration for the agreement (i.e., both parties must get something). For example, the employer gets the protection of the non-compete, the employee must get a payment, a pay increase, a contract extension or something. Wisconsin courts have held that simply not getting fired is not adequate consideration since you had the job already. WHAT MUST A DENTAL PRACTICE PROVIDE IN TERMS OF EMPLOYEE BENEFITS FOR PART-TIME EMPLOYEES? This depends on the type of benefit involved. For this discussion we will classify benefits as Employee Retirement Income Security Act covered retirement plans required to be qualified by the Internal Revenue Service for tax purposes, (i.e., 401(k) plans, money purchase plans, defined benefit plans), group health insurance plans and all other employee benefits (vacation, sick time, holiday pay and dental and vision coverage). With retirement plans, you are required to cover all employees 18 years of age or older who accumulate at least 1,000 hours of service (defined as hours for which the employee is compensated, including paid vacation) during the plan year.1 With group health coverage, insurers are required to permit coverage of all employees within a covered group who work at least 30 hours per week (Section 632.745(5) (a), Wisconsin Statutes). Similarly, any employer who offers group health coverage to its full-time employees must at least offer all employees who work 30 or more hours per week an opportunity to be covered. However, while employers must offer that same coverage, there is no requirement that employees who are not full-time be offered the coverage on the same terms as full-time employees. For example, if, as employer, you paid $800 per month of the premium2 for your regular full-time employees, you could make the coverage available to 30-hour per week employees who wish to take it and you/the employer could offer to pay 75 percent, or $600, on the basis they work 75 percent of fulltime, pay nothing or pay something in between. Regardless, you need to give all 30 or more hours per week employees an opportunity to be in the plan and pay the selected cost level on their own.3 Lastly, you have very broad discretion on what you make available to part-time employees in terms of other employee benefits. You need not make any other types of benefits, including paid holidays, vacation, dental or vision care available. Alternatively, you can make them available in different amounts or on different terms than you make them available to full-time employees (subject to the preceding footnote on making coverage available for up to 18 months for terminated employees). ________________________

Frequently Asked Practice and Legal Questions

Frequently Asked Practice and Legal Questions Compensation and benefits – Your rate of compensation should be stated (e.g., $x.00 per month or $y.00 per annum), as should any agreed upon increases and/or review and/ or adjustment periods. For example, reviewed and adjusted after six months, reviewed every six months and adjusted annually, reviewed and adjusted annually. Also, if there is to be a bonus that would normally be stated along with agreed upon criteria for determining the bonus (e.g., based on total net income of the practice, your individual contribution to the net income of the practice, the number of patients treated, other performance measures). It is particularly easy to have misunderstandings about benefits. While you may not want to list every benefit in the contract, you may want to identify them in an attachment. The most common benefits are medical insurance, dental coverage, vision insurance, group life coverage, disability coverage, vacation and sick days and some form of retirement program/ contributions. You should know what these benefits cover, what they cost and what portion of the cost is paid by the employer. Patients – Another often neglected issue is the disposition of patients and patient records if you leave the practice. If the patients you care for are to be yours and not the practice’s, making it possible for them to follow you if you leave, should be spelled out. Potential purchase of practice share – Another item that can be covered in either an employment agreement or a separate document is a potential opportunity to buy into the practice. If that is really a part of your bargain and not just a nebulous reference to future possibilities, it should be in writing. The agreement should cover timing (set date or list any time after specific date), what percentage of the practice you can purchase (if you are not buying the entire practice, there can be issues as to who has the ability to make practice management decisions), the price or formula to determine price and possibly changes in compensation (e.g., change from a salary to a partnership share). There are, of course, other issues you may wish to cover depending on the particular situation. WHAT ARE THE FEDERAL AND STATE EMPLOYER POSTER REQUIREMENTS? For information on federal and state employer poster requirements, visit the state Department of Workforce Development’s website at www.dwd.state.wi.us/dwd/posters.htm. Often time vendors try to make you purchase these posters for a nominal fee, however, they are free for download online or by calling the noted office directly. WHERE CAN I OBTAIN ASSISTANCE WITH HUMAN RESOURCE QUESTIONS? The WDA has teamed up with The QTI Group to offer important human resources assistance. Services include compensation, employee handbook development, pre-employment screening and measuring employee engagement/satisfaction. The QTI Group is the exclusive and preferred human resources provider for WDA members. See page 100 to learn more about The QTI Group and how their experts can connect you to the right solutions for your practice. 11. AMALGAM RECYCLING AND DENTAL WASTE WHERE CAN I OBTAIN INFORMATION ABOUT AMALGAM RECYCLING AND DENTAL WASTE GUIDELINES? The WDA developed a Best Management Practices brochure on how to manage dental office waste. It includes a contact sheet on various vendors in the state that are licensed by the Wisconsin Department of Natural Resources to assist you in your recycling needs. This can be accessed at WDA.org. 12. OSHA AND CDC GUIDELINES OSHA is a federal agency that protects the health and safety of employees within the workplace. OSHA has a set of federal regulations that apply to dentistry, among other health care professions. These regulations are detailed in the Bloodborne Pathogens Standard (29 CFR1910.1030). The state components of OSHA include the enforcement side, as well as compliance specialists who are in place to assist employers with compliance-related issues. For more information, visit www.osha.gov/SLTC/dentistry/index.html. HOW CAN I OBTAIN THE CDC’S STERILIZATION GUIDELINES? The CDC has updated their guidelines for infection control and sterilization. In Wisconsin, the DEB has adapted these guidelines as requirements for all licensed dentists.

2014 WDA Sourcebook

For more information please visit: http://www.ada.org/productguide/p/1136/Practice-Management/The-ADA-PracticalGuide-to-Effective-Infection-Control ARE THERE SPECIFIC STERILIZATION GUIDELINES FOR DENTAL OFFICE INSTRUMENTS AND EQUIPMENT? The CDC has a specific set of guidelines for proper sterilization of dental office instruments and equipment. It is important that each dental office take seriously its responsibility to follow appropriate CDC sterilization guidelines. For more information, visit www.infection-control.com/CDCDental-Guidelines.html. I HEARD OSHA MADE SOME CHANGES TO THE HAZARD COMMUNICATION STANDARD, WHAT ARE THEY? In December 2013, Occupational Safety and Health Administration created changes to the Hazard Communication Standard which will help align the United States with the Globally Harmonized System of Classification and Labeling of Chemicals to improve safety. The newly modified standard provides a single set of criteria used for classifying chemicals according to their health and physical hazards and specifies hazard communication elements for labeling and safety data sheets. The changes include hazard classification, labels, safety data sheets and information/training. Dental offices are still required to do annual OSHA training with staff in which this update can be incorporated. The in-office OSHA point person should review and become familiar with the new Hazard Communication Standard (new label elements and Safety Data Sheet/SDS format) and review it with all staff to be compliant which as by Dec. 1, 2013. Additional information and details can be found at: https://www.osha.gov/dsg/hazcom/HCSFactsheet.html https://www.osha.gov/dsg/hazcom/ghs.html. 13. MALPRACTICE WHAT IS THE STATUTE OF LIMITATIONS FOR DENTAL MALPRACTICE ACTIONS? The statute of limitations for dental malpractice actions based upon an injury arising from any treatment or any omitted treatment by a dentist is 893.44(1), Stats. The statute provides that the action must be commenced within the later of: 1. Three years from the date of the injury 2. One year from the date the injury was discovered, or in the exercise of reasonable diligence should have been discovered 3.No case more than five years from the date of the act or omission. There are two exceptions to the statute of limitations. 893.55(2) provides if a dentist conceals from a patient a prior act or omission which has resulted in an injury to the patient, the action must be commenced within one year from the date the patient discovers the concealment or, in the exercise of reasonable diligence, should have discovered the concealment. 893.55(3) provides when a foreign object, which has no therapeutic or diagnostic purpose or effect, has been left in the patient’s body, the action must be commenced within one year after the patient is aware or, in the exercise of reasonable diligence should have been aware, of the presence of that action. The statute of limitations which applies in an action by a minor (under the age of 18) against a dentist is 893.56, Stats. That statute provides action must be filed within the later of the time periods set out in 803.55, or by the time the minor reaches the age of 10 years. Such an action must be brought by the parent or guardian of the minor. 14. MANDATORY INSURANCE/BENEFIT COVERAGE WHAT IS THE STATUTE REGARDING MANDATORY COVERAGE FOR TMD? In 1997, the Wisconsin statutes were changed to include insurance mandates for TMD coverage. 632.895 Mandatory coverage. (1) Definitions. In this section: (a) “Disability insurance policies” mean surgical, medical, hospital, major medical or other health service coverage but does not include hospital indemnity policies or ancillary coverage such as income continuation, loss of time or accident benefits. 632.895 (11) Except as provided in par.(e), every disability insurance policy and every self-insured health plan of the state or a county, city, village, town or school district that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle or tissue shall provide

Frequently Asked Practice and Legal Questions

15. PATIENT ABANDONMENT HOW CAN I END A DOCTOR/PATIENT RELATIONSHIP AND AVOID ABANDONMENT?

The relationship can terminate for many reasons. Some of the typical reasons the relationship might end are: • The patient changes dentists • The patient moves • The dentist moves • The dentist retires, or sells the practice The dentist may initiate termination if patient fails to: • Cooperate with prescribed treatment • Pay for services • Doesn’t show up for appointments When the relationship ends, certain precautions should be taken so the dentist can establish he/she did not abandon the patient. These precautions are if the patient terminates the relationship: • Be cooperative • Offer to forward records to the new dentist • Document the patient’s decision in your dental record • Advise the patient, in writing, of incomplete treatment plans • Recommend continuation of unfinished treatment 16. X-RAYS AND EXAMS WHAT DO I NEED TO BE CONCERNED ABOUT IF A PATIENT REQUESTS THAT I NOT DO AN EXAM OR TAKE X-RAYS (E.G., BECAUSE OF FEAR OF RADIATION OR FINANCIAL REASONS)? Wisconsin law requires that patients being seen by a dental hygienist without the dentist present must have been examined by the dentist within the last 12 months. It doesn’t dictate how often exams must be provided if the dentist is always present but from a liability standpoint, a dentist should examine a patient on a regular basis. The WDA recommends the office establish a policy on frequency of dental examinations, and implement it for all patients. Other factors may also influence how often a dentist should examine a patient. A dentist should perform an exam before providing clinical care. Without a thorough patient exam, it is nearly impossible for a dentist to provide an accurate diagnosis and appropriate treatment. In addition, patients may need to be seen more frequently if they have serious or ongoing oral health issues. Although the collection of health information and some components of the dental examination may be delegated, a dental hygienists’ scope of care does not include the ability to provide a dental examination. The evaluation, diagnosis and treatment planning are clearly the responsibility of a dentist and exams are only billable under CDT guidelines if performed by a dentist. A dental hygienist cannot bill for an examination. X-rays are one of the many tools a dentist uses in order to provide thorough dental exams, and while there is no statutory direction as to how often a dentist must take X-rays, there is a general liability issue. Dentists should take X-rays in a “reasonable” time span (one to five years) to show the dentist didn’t disregard patient’s oral health care. A dentist isn’t legally required to take X-rays every six months or every year, particularly for patients who enjoy good oral health. However, if the dentist doesn’t take X-rays within a reasonable time span and a diagnosis is missed or discovered later than it should have been, then the dentist will have to defend his decision to examine the patient without taking new X-rays within a reasonable timeframe. The standards of the profession expect that the X-rays are taken in reasonable intervals throughout the patient’s “lifetime” at the dental office. Dentists have the right to set a policy in their office dictating how often exams and x-rays are performed for diagnostic purposes. If the dentist has a policy that X-rays are to be taken at a given intervals along with an exam being performed, and the patient refuses, the dentist has the right to dismiss the patient from his or her practice. (See information on dismissing a patient.) The patient and dentist should be comfortable with the dentist/patient relationship, and should there be disagreement on fundamental treatment, then both parties would be better served by parting ways.

Frequently Asked Practice and Legal Questions

coverage for diagnostic procedures and medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders if all the following apply: • The condition is caused by congenital, developmental or acquired deformity, disease or injury. • Under the accepted standards of the profession of the health care provider rendering the service, the procedure or device is reasonable and appropriate for the diagnosis or treatment of the condition. • The purpose of the procedure or device is to control or eliminate infection, pain, disease or dysfunction. Coverage required under this subsection: o Includes nonsurgical treatment includes coverage for prescribed intraoral splint therapy devices. o Does not include coverage for cosmetic or elective orthodontic care, periodontics care or general dental care o May be subject to any limitations, exclusions or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan. o May not exceed $1. 250 annually for diagnostic procedures and medically necessary non-surgical treatment for the correction of temporomandibular disorders An insurer or a self-insured health plan of the state or a county, city, village, town or school district may require an insured obtain prior authorization for any medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders. This does not apply to a disability insurance policy that covers only dental care or a Medicare supplement policy, as defined in s. 600.03 (28r). WHAT IS THE STATUTE REGARDING MANDATORY COVERAGE FOR HOSPITALIZATION AND GENERAL ANESTHESIA? In 1997, Wisconsin statutes were changed to include an insurance mandate for coverage of anesthesia and hospital charges relating to the delivery of oral health care services. The mandate reads as follows: 632.895 Mandatory coverage. (1) Definitions. In this section: (a) “Disability insurance policies” mean surgical, medical, hospital, major medical or other health service coverage but does not include hospital indemnity policies or ancillary coverage, such as income continuation, loss of time or accident benefits. 632.895 (12) Hospital and Ambulatory Surgery Center Charges and Anesthetics for Dental Care.(a) In this subsection, “ambulatory surgery center” has the meaning given in s. 49.45 (6r) (a) 1. (b) Except as provided in par. (d), every disability insurance policy and every self-insured health plan of the state or a county, city, village, town or school district shall cover hospital or ambulatory surgery center charges incurred and anesthetics provided, in conjunction with dental care provided to a covered individual in a hospital or ambulatory surgery center, if any of the following applies: • The individual is a child under the age of five. • The individual has a chronic disability that meets all of the conditions under s 230.04 (9r) (a)2. a., b. and c. (see following section, 230.04 State Employment Relations). • The individual has a medical condition that requires hospitalization or general anesthesia for dental care. (c) The coverage required under this subsection may be subject to any limitations, exclusions or cost-sharing provisions that apply generally under the disability insurance policy or self-insured plan. (d) This subsection does not apply to a disability insurance policy that covers only dental care. 230.04 State Employment Relations (9r) (a) In this subsection: 2. “Severely disabled employee” means an employee in the classified service with a chronic disability if the chronic disability meets all of the following conditions: • It is attributable to a mental or physical impairment or combination of mental and physical impairments. • It is likely to continue indefinitely. • It results in substantial function limitations in one or more of the following areas of major life activity, including self-care, receptive and expressive language, learning, mobility and capacity for independent living; and economic self-sufficiency.

The doctor/patient relationship is the central focus of any dental practice. There are legal issues to consider for properly ending the doctor/patient relationship. 2014 WDA Sourcebook

Recommended Products, Programs and Services

Recommended Products, Programs and Services Your association did the research, you reap the benefits! PRACTICE MANAGEMENT

Recommended Products, Programs and Services

AED Brands (defibrillators) – As one of the largest AED distributors in the country, AED Brands is an authorized distributor for all AED manufacturers. A trained staff will help WDA members select the AED best suited for their office. Models include brands such as Philips, Cardiac Science, Zoll and more. They provide product expertise, prompt service, and discount pricing for WDA members. An AED is designed to treat the most common cause of death – Sudden Cardiac Arrest. For more information, contact AED Brands at 800-580-1375 or visit www.AEDbrands.com.

Association Gloves (examination gloves) – Enjoy special WDA-member prices and free shipping on all orders. Major glove brands offered, including Cranberry, EcoBee, Microflex, Sempermed and Kimberly-Clark. Association Gloves also offers a large selection of Kimberly-Clark ear loop and tie masks, including Level 1, 2 and 3 American Society for Testing and Materials-rated masks. All products sold by the case. Place your first glove order and receive a Starbucks gift card. Buy one case of masks, and get two boxes free. Visit www.wdagloves.com for more information or call 877-484-6149 to request free samples and place an order.

AMO – Association Members Only (office supplies) – Check out the fantastic meetor-beat pricing on quality office products with next-day deliveries in most areas of the state. There are instant rebates on thousands of general office supplies. Ordering is simple online, on the phone or by fax. Call 800-420-6421 or visit www.goamo.com to find out more.

CareerConnection (online job center) – WDA CareerConnection is the only job center exclusively for dental careers and employment connections in Wisconsin serving dentists, hygienists, assistants, lab techs and more. For more information, visit careers.wda.org.

The Dental Record (paper records) – The Dental Record is the top-quality recordkeeping system created by dentists for dentists and is the only system endorsed by the American Dental Association. It is the most comprehensive system available and offers a variety of charts, forms, an Emergency Record, labeling systems, recall cards and open-shelf cabinets. It is recognized as the standard of excellence in an easy-to-use format. To place an order or request a catalog, call 800-243-4675 or visit www.dentalrecord.com.

DentForms by MedicTalk (digital signatures) – Go paperless with DentForms. This digital signature software solution allows you to keep completely paperless patient records. You can create your own forms or use the forms in the system. There are 50 completely customizable forms and questionnaires. Your patients can even complete the forms online prior to their visit with the information automatically transferred into the DentForms system. This solution bridges to any Windows-based practice management software. To set up a product demonstration, call 800-243-4675 or log on to www.dentalrecord.com/dentforms for more information.

2014 WDA Sourcebook

Central Data Storage (online data backup) – Secure your data with Managed Online Data Backup and Recovery. Have professionals securely and automatically backup your important data daily through the Web. That data is then stored in two highly secure data centers and is available 24/7 if you should need to restore any files. Your data is always compressed and encrypted, making you compliant with HIPAA security regulations. Visit www.dentalrecord.com/centraldatastorage or call 800-243-4675 for more information.

InTouch Practice Communications (Custom On Hold Advertising and Appointment Reminder System) – Best-in-class system identified and endorsed by ADA Business Resources. Products to enhance your professional image, educate existing and prospective patients and remind them of their appointments. Call 877-493-9003 or visit www.intouchdental.com.

Officite (websites) – The leading provider of dental websites and local Internet marketing solutions. Officite provides WDA members exceptional websites and expert search engine marketing strategies, from setup to ongoing maintenance and site optimization, with top-quality customer service. Its local-search solutions and turnkey-marketing programs are designed to help practices attract new patients, educate clients and create a unique presence in the marketplace. Call 888-738-8834 or visit www.officite.com/wda.

The Omnia Group, Inc. (pre-employment testing and background checks) – Let the Omnia Group help you find the best employee for your practice. Omnia offers personality testing that determines if a potential new employee will work well with you and other employees. Background checks, including credit and criminal histories are also available. Call 800-525-7117 or visit www.OmniaGroup.net for more information on testing. Background checks are at www.CheckPast.com.

The QTI Group (Human Resources) – Headquartered in Madison with 11 locations throughout the state, The QTI Group provides services for staffing, recruiting, executive search, compensation design and incentive plans. HR startup kits, consulting and full outsourcing (e.g., benefits, payroll) also is available for your dental office. Consultants are experienced, knowledgeable and engaged. Visit www.qtigroup.com or call 888-575-3273 to learn more. Be sure to ask about the “Free 15”, which is 15 minutes of free HR consulting services for WDA members each calendar year.

Scientific Metals (metal refining) – Scientific Metals provides a wide variety of precious metal refining services including gold, platinum, palladium and silver. Settlement is based on the average daily London PM prices from the day we receive your scrap to the settlement day. Payment can be received with check or gold/silver bullion. Call 888-949-0008 or visit us at http://scientificmetals.com/wda to see some of the great associations who have entrusted us with their members’ scrap.

Recommended Products, Programs and Services FINANCIAL SERVICES

how to optimize and systemize your A/R process, please call 608-276-8307 or visit www.web.transworldsystems.com/madison.

OTHER PRODUCTS AMP Wealth Management (401(k) Plans, and Personal Wealth Management) – AMP Wealth Management uses a quantitative investment approach for managing your portfolio for retirement. We employ three investment strategies: an Equity Portfolio with a value based approach and fundamental analysis, an Income Portfolio tailored to your individual income needs, and Risk Based Portfolios to meet your individual risk tolerance. Please call us at 414-332-1011 or visit www.ampinvestment.com to discuss your financial future.

CareCredit (patient financing) – Make it easier for more patients to get the care they want, when they want by adding CareCredit, a health care credit card, as an additional payment option. During past 25 years, more than 20 million patients have chosen to use CareCredit and an estimated 90,000 enrolled dental patients accept CareCredit. In celebration CareCredit’s 25th anniversary, you can get started for only $25. Call 800-300-3046, ext. 4519 or visit www.carecredit.com/dental. Already offer CareCredit? Call 800-859-9975.

Mercer Advisors (financial planning) – Mercer Advisors is one of the nation’s largest planning and investment management firms servicing dentists. In addition, services include retirement plans and estate planning. Mercer Global Advisors is registered with the Securities and Exchange Commission and renders all investment related services. If you are looking for renewed prosperity for your practice and your life, call 800-898-4642 or visit www.merceradvisors.com. ADA Visa Card from U.S. Bank (credit card) – Sign up for best-in-class rewards and enhanced customer service. You can redeem your rewards for unique travel, dining and entertainment. Current ADA World MasterCard members will automatically receive the new ADA Visa Card in the mail. Contact U.S.Bank at 888-327-2265 x94225 or visit www.usbank.com/ADA94225 to learn more.

U.S. Bank Practice Finance (practice and commercial real estate financing)- U.S. Bank Practice Finance is one of the top dental finance leaders in the country. We provide the benefits of working with a strong and stable financial institution, along with extensive knowledge of the dental industry, giving us a thorough understanding of your practice’s financial needs. We offer financing for acquisitions, buy-ins, practice expansions, startups, practice debt refinance and equipment. In addition, U.S. Bank specializes in real estate and line of credit financing and can provide comprehensive banking services for your business. To learn more about how we can take your business to the next level, call Zach Te Winkel at 414-765-5498 or visit www.usbank.com/small-business/practice-finance.

Lands’ End (staff apparel) – Give your staff a unified image with apparel from Lands’ End Business Outfitters. Personalize your gear with your practice’s logo to give your team a professional look. Call Lands’ End at 800-990-5407 to speak with your dedicated consultant or find more information online.

Mercedes-Benz (vehicles) – Members can now save $1,000 to $4,000 on the purchase or lease of a new Mercedes-Benz. This leader in luxury vehicles offers more than 55 models to satisfy every driving style. Learn more or call (866) 628-7232 to learn about this exciting new member discount on Mercedes-Benz vehicle.

UPS (shipping) – WDA members can save up to 36 percent on a broad portfolio of UPS shipping services. Whether you need your lab shipments or important documents to arrive the next day or are looking for the most affordable shipping option, UPS understands the importance of reliability, speed and cost. Visit savewithups.com/ada or call 1-800-MEMBERS to move the account into the program and begin saving.

Whirlpool Appliances (home appliances) – As an ADA member, you can receive substantial savings along with special promotions through the VIPLINK™ Program by Whirlpool Corporation, the world’s leading manufacturer of major home appliances. Visit their exclusive site to choose from hundreds of products for your practice (or for your home). You’ll find industry-leading brands such as Whirlpool®, KitchenAid®, Maytag®, Amana®, Gladiator® GarageWorks and more. You can purchase up to 12 products every year. Call 866-808-9274 or visit www.partners.whirlpool.com (have your ADA membership number and group code ready).

Recommended Products, Programs and Services

Chase Paymentech (credit card processing) – Today more than 25 percent of patients pay for dental treatment with a credit card. And, more than 5,000 dental practices are turning to Chase Paymentech to process their payments securely, reliably and inexpensively. With the ADA member rate, practices could save as much as $1,000 annually. Call 800-618-1666 for a complimentary analysis of your current payment processing or visit www.bestpaymentprocessing.com/ada.

HP – Business Products (computers, tablets, servers) – Whatever computer hardware needs you have – from notebooks and desktops to printers, scanners, servers, storage, networking and more – as a WDA and ADA member you’ll save up to 30 percent on every item. Or, tap into Hewlett-Packard Co.’s trade-in program and give your practice a technology upgrade at amazingly favorable members-only prices! Call 800-888-4164 and mention the ADA or visit www.hp.com/go/ada.

Brought to WDA Members by:

Transworld Systems Inc. (credit and collections)- Transworld Systems Inc. is the nation’s leader for helping more than 12,000 dental practices improve their accounts receivable process. From contacting patients diplomatically in the name of the practice using our innovative Accelerator program, to pre-collection all the way to full collection and legal action, Transworld has the level of intensity that suits your practice. Our new Dental Collect program seamlessly interfaces with the majority of Practice Management Software companies and helps identify past-due patient balances in seconds. To learn 2014 WDA Sourcebook

Professional Insurance Programs

YOUR FULL-SERVICE INSURANCE AGENCY HELPING YOU protect WHAT MATTERS most Our commitment is to provide Wisconsin dentists with solid advice backed by comprehensive and affordable insurance solutions offered through the most respected carriers in the insurance industry.

Professional Insurance Programs

Professional Insurance Programs’ staff keeps abreast of the changes occurring in your profession and within the insurance industry. We will listen to your concerns and be your resource as to which insurance programs should be part of your portfolio to ensure your assets are protected. We are a full-service insurance agency and provide a wide variety of programs through numerous carriers, some of our key programs and partners are listed below: Professional Liability and Office Protection The CNA Professional Protector Plan® is a complete package of protection and is available in Wisconsin exclusively through PIP. Workers’ Compensation This WDA group program was developed to help participants better manage the cost of workers’ compensation insurance. Special “needle stick” coverage has been added to protect the dentist, staff and patient and is underwritten by West Bend Mutual Insurance Company. WDA Group Life and Disability Insurance Program As a member of the WDA, you have the exclusive opportunity to protect your income and gain financial security with life and disability products custom designed for you. Auto and Homeowners’ Insurance The WDA has endorsed West Bend Mutual Insurance Company’s “Association Plus” Home and Highway program. We also represent a variety of carriers including Secura, Auto-Owners and Progressive to enable us to truly customize your coverage.

You also have access to expertise in: n Employee benefits n Office overhead expense coverage n Group health insurance n Long-term care insurance n Individual life insurance and disability insurance n Advanced planning services • Business succession planning • Business overhead insurance • Disability buy-out insurance • Estate planning • Planned giving programs n n n

Medicare supplement programs – HSAs, HRAs & MSAs Flexible spending account Direct reimbursement

A division of:

ADVICE – SOLUTIONS – RESOURCES We invite you to take advantage of these quality plans and their high-level benefits geared to the special needs of Wisconsin’s dental community. Allow PIP to be your trusted partner, invaluable resource and a true member benefit. Contact us today at 800-637-4676, 414-277-0154, info@insuranceformembers.net or visit our website at www.insuranceformembers.com. 100

2014 WDA Sourcebook

Member Directory

Pyramid of Pride Recognition Program

Pyramid of Pride Recognition Program The Wisconsin Dental Association is proud to honor the 2013 Pyramid of Pride recipients who received their awards during a special dinner on Nov. 15, 2013 at the Marriott Madison West in Middleton.

Lifetime Achievement Award Dr. Dennis Engel (Mequon)

Mequon resident and general dentist Dr. Dennis Engel received the 2013 Wisconsin Dental Association Lifetime Achievement Award in recognition of his significant contributions of time, energy and expertise to organized dentistry throughout his career.

Active at all levels of the tripartite, Dr. Engel has served in many capacities including that of committee member and/or committee for the WDA’s Workforce Committee, Access to Care Task Force and Amalgam Task Force.

He served for numerous years as a delegate or alternate to the WDA and American Dental Association House of Delegates. He was also as treasurer for Wisconsin Dental Political Action Committee and an Action Team Leader. While he started as “sign boy” for the Annual Session Committee, his went on to become the editor of the WDA Journal from 1994-2002 and again from 2006-10, as well as WDA president from 2003-04 and ADA 9th District Trustee from 2009-13. Dr. Engel also served on the Dean’s Advisory Council at Marquette University School of Dentistry and as editor of the International College of Dentistry. He is a fellow with the Pierre Fauchard Academy, International College of Dentists and American College of Dentists.

Friends of Dentistry Award

Political Action Award

Dr. Robert Dillman (Lake Geneva)

Dr. Ed Chiera (Beloit)

Dr. Debra Palmer (Racine)

Dr. Dave Clemens (Wisconsin Dells)

Pyramid of Pride Recognition Program

WDA Community Outreach Award

New Dentist Leadership Award Robert Glass, executive director, Tri County Community Dental Clinic in Appleton

Dr. Jane Wright (Kenosha)

WDA Award of Honor Kathleen Hess Hess Design Group

Outstanding Leadership in Mentoring WDA Foundation Philanthropic Award Dr. Ronald Stifter (Saukville)

Dr. Monica Hebl (Milwaukee)

Nominations are accepted year-round; Submit by July 15, 2014 to be considered for a 2014 award. See reverse side for award nomination form and visit WDA.org for complete descriptions. 2014 WDA Sourcebook

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