WDA Sourcebook 2013

Member Directory & Practice Guide 2013

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LODI

DENTAL STUDENT

ASSOCIATE

PEDIATRIC

MILITARY RESEARCHER

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ENDODONTIST

WDA MEMBER

RDH

PUBLIC HEALTH

FUTURE PARTNER PERIODONTIST

GENERAL PART-TIME ORAL SURGEON MADISON SECOND GENERATION MILWAUKEE

RETIRED

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FOREIGNTRAINED

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WDA President Dr. Timothy Durtsche April 2013

On behalf of the Wisconsin Dental Association, I am pleased to provide you with this copy of the 2013 WDA Sourcebook (Member Directory & Practice Guide). A valuable, desktop reference, it is used year-round by our more than 3,000 member dentists, 100 member dental hygienists and dental office teams.

The 2013 edition features: • NEW dental hygienist listing in member directory • NEW WDA Legislative Priorities and updated legislator list • Two tabs for easy, quick reference • Contact information for leadership, component officers and staff • State dental licensure CE requirements This year’s cover visually represents the new “We Are the WDA” membership campaign with photos of various members. We may practice in different areas of the state, in different specialties or general dentistry and in different business models. Some of us are faculty members, second-generation dental professionals, new graduates or retired.

Together, “We Are the WDA” and organized dentistry in Wisconsin. I am proud to be a WDA member and join in our united voice.

Dentistry is facing new challenges, including non-covered services, assignment of benefits, expansion of dental schools and changes in workforce. Now, more than ever, we need to focus on the dental profession’s core values. Prevention has always been a hallmark of dentistry and we need this to continue, but not just in our own offices. We need to be even more active in our communities and schools.

We need to be the resource and authority for every aspect of oral health.

Thank you to WDA Insurance and Services Corp. for providing financial support for this valued resource and our sincere appreciation to our 10 sourcebook advertisers.

I hope you and your staff find value in this 2013 edition of the WDA Sourcebook! 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 for your ongoing membership and commitment to organized dentistry.

Dr. Timothy Durtsche WDA President 2012-2013 La Crosse tdurtsche@wda.org

Tim Durtsche, DDS WDA President, 2012-13 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.

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ADA 9th District Trustee Dr. Dennis Engel April 2013

The tripartite is a unique relationship linking local components with the Wisconsin Dental Association and the American Dental Association.

Twenty years ago, when I had the opportunity to serve in a leadership role, I interacted with members at all levels. I quickly learned if I wanted to understand the complexities of our profession, I needed to experience the needs of our grassroots members around the state.

The future of organized dentistry lies in its grassroots members and the communication channels established between them and executive leadership within the tripartite.

At times, individual strategic plans and goals at the local, state and national levels exhibit different priorities. We need to find a way to be united in our efforts to succeed in supporting a diverse membership.

I didn’t fully appreciate the breadth of the word “diverse”, until I served at the ADA level.

Though there are many commonalities connecting all dentists, there are even more differences defined by factors ranging from ethnicity and gender to practice model and specialty.

Once we understand the value of being inclusive instead of exclusive, we can move on to reframe the issues surrounding the access to care debate. The ADA needs to be positioned as a knowledge broker and as an indispensable part of the solution.

ADA Immediate Past-President Dr. William Calnon says the association needs to be a provider of, “…actionable policy interventions to improve the oral health of the public.” Those interventions need to be perceived as objective, evidenced-based, credible, reliable and trustworthy.

Governance remains a challenge. Many of the ADA House of Delegates’ recommendations are being implemented. Despite information gathered from surveys and stakeholder groups, two huge hurdles still exist – the size of the House and the ADA council structure.

As issues are debated, leaders must remember to act in the association’s best interest. If the Titanic had been more nimble, it would have missed the ice berg.

The budget process also needs attention. It is an arduous process lacking program flexibility.

The ADA is making strides in tackling these key issues and will continue to do so in the next year.

Dr. Oliver Wendall Holmes, an iconic writer and poet, once said, “A mind that is stretched by a new experience can never go back to its old dimensions.”

Serving as your ADA 9th District trustee for the past three years has changed my life forever.

Thank you all for the opportunity.

Dennis Engel, DDS ADA 9th District Trustee

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Dr. Dennis Engel ADA 9th District Trustee Mequon engeld@ada.org

2013 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 10 E. Doty St., Ste. 509 Madison, WI 53703 608-250-3442 or 888-538-8932 fax 608-282-7716 or 888-822-2932

WDA.org Connect with us on:

The WDA used 2012 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 148 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 WDA 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 Member Get a Member ...................................................................................26 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 ...................................................................................................33 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 WDA Insurance Programs...............................................................................100 Member Directory Pyramid of Pride Awards ................................................................................101 POP nomination form....................................................................................102 Active Dentists ................................................................................................103 Active Dental Hygienists ..................................................................................134 Dental Hygienist Membership..........................................................................135 Active Dentists by City ....................................................................................136 Retired Dentists ...............................................................................................142 CE Cruise.......................................................................................................148 Past-President Listing .......................................................................................149 Update Your WDA Listing ...............................................................................150

WDA Sourcebook Conditions of Use The Wisconsin Dental Association Sourcebook (Member Directory & Practice Guide) is published annually as a member service.

Members’ 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.

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WDA Strategic Plan

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.

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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.

Top row left to right: Drs. Renita Burrell, Robert Konen, Gary Stafford, Holly Grimslid, Allison Dowd and Joshua Barta.

Second row left to right: Drs. John Grignon, Jason Luecht and Erica Stanek Third row left to right: Drs. Patrick Tepe, Leslie Showalter, Denis Lynch and Rose Pham Fourth row left to right: Drs. Lynne Brock, Edward Lin and Thomas Reid Fifth row left to right: Drs. William Mauthe, Heidi Eggers-Ulve and Constantine Stamatelakys Bottom row left to right: Drs. Adriana Jaramillo, Daniel Kujak, Allison Mantel and Tipton Brown 2013 WDA Sourcebook

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Regions and Components

Regions and Components

DOUGLAS

BAYFIELD IRON ASHLAND

BURNETT

WASHBURN

VILAS

SAWYER

FLORENCE ONEIDA

PRICE POLK

FOREST

MARINETTE

RUSK

BARRON

LINCOLN

LANGLADE

TAYLOR ST. CROIX

CHIPPEWA

MENOMINEE*

DUNN MARATHON

PIERCE

EAU CLAIRE

DOOR

OCONTO

SHAWANO

CLARK PORTAGE

WAUPACA OUTAGAMIE BROWN

U EALEA

BUFFALO

TREMP

PEPIN

WOOD

KEWAUNEE

JACKSON WAUSHARA

ADAMS LACROSSE

MANITOWOC

WINNEBAGO CALUMET

MONROE MARQUETTE

JUNEAU

GREEN LAKE

FOND DU LAC

SHEBOYGAN

COLUMBIA

GT

DODGE

IN

SAUK

SH

RICHLAND

OZAUKEE

WA

CRAWFORD

ON

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

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2013 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 Dane County Dental Society: Dane County Green County Dental Society: Green County 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 ASDA Chapter *Menominee Indian Reservation

Officers and Trustees

WDA Officers

Dr. Julio Rodriguez President-Elect Brodhead jrodriguez@wda.org

Dr. Paul Levine Vice President Milwaukee plevine@wda.org

Dr. Steven Stoll Past-President Neenah sstoll@wda.org

Officers and Trustees

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

Dr. John R. Moser Treasurer Milwaukee jmoser@wda.org Terms of Officers & Trustees Nov. 2012 Nov. 2013

Mr. Mark Paget Executive Director/Secretary West Allis mpaget@wda.org

Dr. Richard Lofthouse Speaker of the House of Delegates Fennimore dlofthouse@wda.org

Dr. Dennis Engel 9th District ADA Trustee Mequon engeld@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@wda.org

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. Ryan Braden Region 4 Lake Geneva rbraden@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 nmurphy@ameritech.net

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

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

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

Mr. Derek Schmidt Region 6 Marquette University School of Dentistry student dschmidt@wda.org 2013 WDA Sourcebook

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Component Officers PLEASE NOTE: Component officers change throughout the

Component Officers

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 Vijay Parmar, President...................... 920-499-0471 Lee Bialkowski, Vice President............. 920-336-2299 Zachary Graf, Treasurer..................... 920-494-9541 Stephen Lasslo, Secretary................... 920-532-0091 Burlington Dental Society Trustee Liaison: Dr. Ryan Braden Ted Hughes, President ....................... 262-248-8766 Chad Greving, Vice President............. 262-723-2900 Bryan Van Oven, Secretary................ 262-763-8101 Mark Braden, Treasurer.................... 262-248-0120 Central Wisconsin Dental Society Trustee Liaison: Dr. Jennifer Peglow Susan Stacker, President ................... 715-845-7759 Elizabeth Doolittle, President-Elect ...... 715-424-2301 Columbia Dodge Marquette County Dental Society Trustee Liaison: Dr. Dave Clemens Jared Homan, President ................... 920-324-4218 Ross Werner, Treasurer...................... 920-326-3191 Dane County Dental Society Trustee Liaison: Dr. L. Stanley Brysh Terry Donnelly, President................... 608-833-1889 Thomas Reid, Vice President.............. 608-222-8344 Michael Kokott, Treasurer ................. 608-848-4000 Allison Dowd, Secretary/Membership Chair ....................................................... 608-288-1543 www.danecountydental.com Fond du Lac County Dental Society Trustee Liaison: Dr. Jeff Kraig William Mauthe III, President............. 920-921-1244 Tim Harper, Secretary/Treasurer........ 920-922-7720 Greater Milwaukee Dental Association Trustee Liaisons: Drs. Thomas Kielma, Lynn Lepak-McSorley and Thomas Raimann Chan Tran, President......................... 262-782-6311 Lynn Lepak-McSorley, President-Elect....... 414-383-8787 Russell Dunkel, Vice President............ 414-427-8565 Richard Mueller, Treasurer.................. 414-425-1510 Charles Lenarduzzi, Secretary............ 414-771-2345 www.gmda.org 8

2013 WDA Sourcebook

Green County Dental Society Trustee Liaison: Dr. Patrick Tepe Drew Delforge, President .................. 608-325-4995 James Winn, Secretary/Treasurer ..... 608-938-4001 Jefferson County Dental Society Trustee Liaison: Dr. L. Stanley Brysh Jennifer Stafford, President ................ 920-563-7323 Brenda Garrison, Vice President......... 920-563-9373 Philip Grosnick, Secretary/Treasurer ........ 920-261-2828 Leslie Showalter, Membership Chair...... 920-563-4415 Kenosha County Dental Society Trustee Liaison: Dr. Ned Murphy Michael Frantal, President ................ 262-694-1100 Bryon Kozak, President-Elect............... 262-697-8766 Laura Guttormsen, Vice President....... 262-654-0267 James Fulmer, Treasurer...................... 262-657-5408 Jane Wright, Secretary...................... 262-694-5272 La Crosse District Dental Society Trustee Liaison: Dr. Dave Clemens Kristine Halverson, President.............. 608-783-7330 Erica Stanek, Vice President............... 608-782-5675 Dan Kujak, Secretary/Treasurer.......... 608-784-4063 Manitowoc Calumet County Dental Society Trustee Liaison: Dr. Pete Hehli Matthew Culligan, President............... 920-682-0321 Ronald Egan, Vice President.............. 920-684-8033 Abbie Kershner, Secretary/Treasurer...... 920-683-2101 Thomas Peterson, Membership Chair..... 920-775-4531 Marinette Oconto County Dental Society Trustee Liaison: Dr. Paul Feit Kurt Aschim, President ...................... 715-732-2601 Robert Dennison, Secretary................ 715-735-3337 Justin Oberdorfer, Treasurer................ 715-735-3337 Northern Wisconsin Dental Society Trustee Liaison: Dr. Jeffrey Nehring John Conkright, President ................. 715-392-4545 Kimberly Hyopponen, Vice President........ 715-682-6675 Jon Nelson, Secretary/Treasurer/Membership ...................................................... 715-398-3239 Northwest District Dental Society Trustee Liaison: Dr. David Kenyon Tom Luepke, President ...................... 715-835-3334 Jason Johnson, Secretary/Treasurer ...... 715-832-5396

Component Officers Washington Ozaukee County Dental Society Trustee Liaison: Dr. Cliff Hartmann Rustin West, President ...................... 262-250-7787 Kelly West, President-Elect.................. 262-377-2668 Jeffrey Burke, Secretary/Treasurer....... 262-240-9840

Racine County Dental Society Trustee Liaison: Dr. Ned Murhpy Debra Palmer, President ...................

Ned Murphy, Secretary ...................

James Luetzow, Treasurer..................

Nicolet De Rose, Membership Chair.....

262-554-9055 262-886-9440 262-554-5468 262-634-8662

Waukesha County Dental Society Trustee Liaison: Dr. Cliff Hartmann Mary Karkow, President.................... 414-476-9400 Joe Best, President-Elect .................... 262-547-8665 Todd Rasch, Vice President/Treasurer . 262-956-6000 Bernhard Bayer, Secretary ................ 262-542-2293

Rock County Dental Society Trustee Liaison: Dr. Ryan Braden Brian Pelsue, President...................... 608-754-4998 Lloyd Smith, Secretary/Treasurer ....... 608-752-6848

Waupaca County Dental Society Trustee Liaison: Dr. Jeff Kraig Karen Johnson, President/Treasurer....... 715-823-2233 Stephen Saunders, Secretary.............. 715-258-3035

Sauk Juneau Adams County Dental Society Trustee Liaison: Dr. Dave Clemens Tiffany Birrenkott, President ............... 608-356-6611 Jeremy Gross, President-Elect ............ 608-254-2345 Amanda Ganshert, Secretary/Treasurer/Membership Chair.............................................. 608-356-3790 Shawano County Dental Society Trustee Liaison: Dr. Paul Feit Joe Mastey, President/Treasurer......... 715-758-2674 Anton Piantek, Secretary................... 715-524-2127

Component Officers

Outagamie County Dental Society Trustee Liaison: Dr. Pete Hehli Jason Cooke, President..................... 920-733-7770 Thomas Lornson, Vice President.......... 920-984-3315 Edward Polzin, Secretary/Treasurer ....... 920-733-8129

Winnebago County Dental Association Trustee Liaison: Dr. Jeff Kraig Jeffrey Keesler, President................... 920-729-0889 Tyler Brown, President-Elect................. 920-725-0400 Shaheda Govani, Secretary............... 920-231-1955 David Mentz, Membership Chair........ 920-722-0530 Michelle Wihlm, Treasurer ................ 920-231-0060

Sheboygan County Dental Society Trustee Liaison: Dr. Pete Hehli Laura Rammer, President .................. 920-458-9331 Robert Armstrong, President-Elect........ 920-458-4142 Mark Bistan, Treasurer....................... 920-457-2255 Jaime Marchi, Secretary ................... 920-452-7336 William Guzzetta, Membership Chair.... 920-564-2925 Southwestern District Dental Society Trustee Liaison: Dr. Patrick Tepe Terrence Moen, President................... 608-647-3222 Matthew Andrews, Vice President....... 608-744-2111 Thomas Williams, Treasurer .............. 608-647-3993 Tri-County Dental Society Trustee Liaison: Dr. Dave Clemens Jeffrey Moos, President .......................... 715-926-5050 Rachel Steele, Vice President ................. 715-284-9409 Jeremy Vogel, Secretary/Treasurer.......... 715-926-4459

Visit WDA.org for upcoming component meetings and events.

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WDA Staff

Executive Office 414-276-4520 or 800-364-7646 • info@wda.org

WDA Staff

Mark Paget Executive Director

Public Relations Carol S. Weber, APR Director of Public Relations

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

Emily Bultman Communications Coordinator and WDA Journal Managing Editor

Lani Becker, CAE Associate Executive Director 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)

Amy Landis Member Relations Coordinator alandis@wda.org 414-755-4126 (direct phone) 414-755-4127 (direct fax)

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2013 WDA Sourcebook

ebultman@wda.org 414-755-4110 (direct phone) 414-755-4111 (direct fax)

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)

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)

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.

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)

WDA Staff

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

Ozaukee, Racine, Rock, Sheboygan, Walworth, Washington, Waukesha and Winnebago counties) 888-338-6852 (toll-free) 414-755-4188 (direct phone) 414-276-8431 (fax)

WDA Insurance & Services Corp.

Mara T. Roberts, CLU, RHU, REBC President mroberts@insuranceformembers.net 414-755-4170 (direct phone) 414-277-1124 (direct fax) Davina Golden Benefits Division Manager dgolden@insuranceformembers.net 414-755-4173 (direct phone) 414- 755-4160

Lisa Koss, MSC Marketing Director lkoss@insuranceformembers.net

See the “WDA Staff” and “Who to Contact” pages for more information.

WDA Foundation • 800-364-7646 Vicki Bohman Executive Director

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

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, 2013 WDA Sourcebook

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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

Who to Contact

Address and email updates (new, changes) Christine, x4116 or cpeacy@wda.org Advertising (WDA Journal, WDA Sourcebook and WDA.org) Emily, x4110 or ebultman@wda.org and Amanda x4112 or abrezgel@wda.org Amalgam Recycling Erika, 888-538-8932 or evaladez@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 “Baby Teeth Matter” Carol, x4108 or cweber@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 CareerConnection (online job board) Amy, x4114 or alandis@wda.org

12

2013 WDA Sourcebook

CE regulations Mara, 888-538-8932 or mbrooks@wda.org Charging interest Erika, 888-538-8932 or evaladez@wda.org Charitable dental care Carol, x4108 or cweber@wda.org Classifieds Emily, x4110 or ebultman@wda.org Classroom/career presentations Emily, x4110 or ebultman@wda.org Code of ethics (WDA and ADA) Kris, x4120 or kanderson@wda.org Codes and claim questions Erika, 888-538-8932 or evaladez@wda.org Community water fluoridation Erika, 888-538-8932 or evaladez@wda.org Component dues payments Christine, x4116 or cpeacy@wda.org Component meetings and rosters Amy, x4126 or alandis@wda.org

Dental assisting and dental hygiene programs Erika, 888-538-8932 or evaladez@wda.org Dental home Carol, x4108 or cweber@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 Direct Giver Program Dana, 888-538-8932 or dponce@wda.org Discounted office supplies (AMO) Susan, x4118 or sjohn@wda.org Donated Dental Services See page 30 Dues Christine, x4116 or cpeacy@wda.org Dues payment processing Anne, x4164 or ahart@wda.org Endorsed products and services See pages 98-99

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

Executive Director’s Update Amanda, x4112 or abrezgel@wda.org

Delegation (dental hygienists and assistants) Mara, 888-538-8932 or mbrooks@wda.org

Forensic identification Kris, x4120 or kanderson@wda.org Give Kids A Smile® Emily, x4110 or ebultman@wda.org

Who to Contact Grants – WDA Foundation Vicki, x4198 or vbohman@wda.org

Hygiene membership Amy, x4126 or alandis@wda.org House of Delegates (WDA and ADA) Lisa, x4104 or lchandre@wda.org Infection control and waste disposal Erika, 888-538-8932 or evaladez@wda.org InSession/Annual Session Lani x4114 or lbecker@wda.org and Susan, x4118 or sjohn@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 and 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 Mediation Services (formerly Peer Review) Kris, x4120 or kanderson@wda.org

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

Member benefits and resources See pages 22-25

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

Membership information Susan, x4118 or sjohn@wda.org See pages 22-25 Membership status reclassification Susan, x4118 or sjohn@wda.org Mentor Program Susan, x4118 or sjohn@wda.org Mission of Mercy Lani, x4114 or lbecker@wda.org National Children’s Dental Health Month Emily, x4110 or ebultman@wda.org Oral health longevity Carol, x4108 or cweber@wda.org OSHA Erika, 888-538-8932 or evaladez@wda.org Patient education materials (brochures) See page 23 Posters (OSHA, state and federal) Erika, 888-538-8932 or evaladez@wda.org Public awareness campaigns Carol, x4108 or cweber@wda.org

Who to Contact

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

Medicaid and BadgerCare Erika, 888-538-8932 or evaladez@wda.org

Social media Amanda, x4112 or abrezgel@wda.org “Starting Your Practice” guide Susan, x4118 or sjohn@wda.org Two Cents for Tooth Sense Mara, 888-538-8932 or mbrooks@wda.org and Carol, x4108 or cweber@wda.org WDA Foundation Vicki, x4198 or vbohman@wda.org WDA Hot Issues Carol, x4108 or cweber@wda.org WDA Insurance and Services Corp.

See page 96 WDA Journal and WDA Sourcebook Emily, x4110 or ebultman@wda.org Website (www.wda.org) Amanda, x4112 or abrezgel@wda.org

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

Wisconsin Dental Political Action Committee (WIDPAC) Dana, 888-538-8932 or dponce@wda.org See pages 50-51

Pyramids of Pride Amy, x4126 or alandis@wda.org

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

Relief Fund Amy, x4126 or alandis@wda.org

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

2013 WDA Sourcebook

13

Directions to the WDA

SHOREWOOD 76TH ST

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

BROOKFIELD

43

WAUWATOSA

MILWAUKEE

N NATIO

ST. FRANCIS

43

S. 70TH ST.

S. 73RD ST.

45

S. 75TH ST.

AVE.

S. 77TH ST.

NAL

NATIO

W. DICKINSON ST. W. WALKER ST. S. 76TH ST.

894

KOPPERUND PARK S. 72ND ST.

S. MOORLAND RD

GREENFIELD AVE

VE. AL A

S. 74TH ST.

W. WASHINGTON ST. W. MADISON ST.

94

WEST ALLIS

S. 71ST ST.

WDA suite is in building two on the third floor. Surface lot parking is available.

W. MAIN ST.

94

Y W PK

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.

KE LA

Directions to the WDA

Directions to the WDA Executive Office in West Allis

W. GREENFIELD AVE.

Directions to the WDA Legislative Office in Madison 10 E. Doty St., Ste 509 Madison, WI 53703 Phone: 608-250-3442 or 888-538-8932 Fax: 608-282-7716 or 888-822-2932

.

St

Use the 10 East Doty Side Entrance & Elevators and not the One East Main Side or 33 East Main.

Webster St.

x

E.

Wilson St.

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n Dr.

John Nole

Butler St.

‡

Main St.

.

St

Doty St.

151/E. Washington Ave.

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2013 WDA Sourcebook

‡

MLK Blvd.

14

Main St. Carroll St.

Use the 10 East Doty Side Entrance & Elevators and not the One East Main Side or 33 East Main.

Fairchild St.

From the Southwest: Take Highway 12, 14, 18 or 151 to Madison; Take Highway 12 East (Beltline East) to John Nolen exit; follow exit all the way downtown through four stop lights. Turn left at Broom St., (which will be your fifth stoplight), go for four blocks to West Washington Ave., and turn right and go for two blocks to Fairchild St.; turn right. Stay in the left lane and follow the capitol loop for four blocks. Immediately after Martin Luther King Blvd., about ½ block, turn left into our orange building parking garage entrance.

151/W. Washington Ave.

Henry St.

Use the 10 East Doty Side Entrance & Elevators and not the One East Main Side or 33 East Main.

Dayton St. Mifflin St.

Broom St.

From the North: Take Highway 90/94 South to Madison; exit Highway 51 South (Stoughton Rd.), proceed straight until you intersect with East Washington Ave. (Hwy 151 South). Turn right onto East Washington Ave. (Hwy 151 South) and take all the way to downtown. Two blocks before you get to the Capitol Concourse, turn left on Butler St., go two blocks to Wilson St., turn right (one-way St.) and go two blocks to Martin Luther King Blvd. and turn right and one block to Doty St. (one-way St.) and turn right. Stay in the left lane, about ½ block and enter left into our orange building parking garage.

x

Pinckney St.

Wisconsin Ave.

e

at

St

From the South and the East: Take Highway 94 West to Madison or Highway 90/94 North to Madison; exit Highway 30; then exit East Washington Ave. (Hwy 151 South) toward the State Capitol. Two blocks before you get to the Capitol Concourse, turn left on Butler St., go two blocks to Wilson St., turn right (one-way St.) and go two blocks to Martin Luther King Blvd. and turn right and go one block to Doty St. (one-way St.) and turn right. Stay in the left lane, about ½ block and turn left into our orange building parking garage entrance.

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WDA Committees 2013 WDA COMMITTEE ROSTER (As of March 27, 2013)

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

Term limits are indicated in parenthesis.

WDA Committees

ADA House Delegates (annual) Dr. Julio Rodriguez, President-Elect, Chair Dr. Timothy Durtsche, President Dr. Paul Levine, Vice President Dr. Dave Kenyon, Region 1 Dr. Jeff Kraig, Region 2 Dr. Thomas Raimann, 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. Kent Vandehaar, Region 1 Dr. Robert Brennan, Region 2 Dr. Pete Hehli, Region 2 Dr. Monica Hebl, Region 3 Dr. H. Michael Kaske, Region 4 Dr. Richard Lofthouse, Region 5 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 (’13) Dr. Pete Hehli (Board Liaison) Dr. Dean Hussong (‘13) Dr. Geoff Mykelby (‘13) Dr. Jon Nelson (’13) 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 (’13) 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. Scott Greatens (’13) 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

16

2013 WDA Sourcebook

Editorial Advisory Board (annual) Dr. Robert Brennan, Editor Dr. Robert Darling Dr. Ellyn English Dr. Glenn Gequillana Dr. Gene Shoemaker Staff liaison: Emily Bultman, 800-364-7646 x4110 Ethics and Dental Relations Committee (3 yr) Dr. Martin Williams, Chair (‘13) Dr. Dennis Abere (’13) Dr. Paula Crum (’15) At Large Dr. Russell Dunkel (’13) Dr. Gerald Feldman (’14) Dr. Julie Fox (’13) Dr. Shaheda Govani (’15) At Large Dr. Cynthia Jarzembinski (’14) Dr. Toni Roucka (’14) At Large Dr. Tamim Sifri (’15) At Large Dr. David Walther (’13) Consultant: Kris Anderson, 800-364-7646 x4120 Executive Committee (annual) Dr. Timothy Durtsche, President, Chair Dr. Julio Rodriguez, President-Elect, Vice Chair Dr. Paul Levine, Vice President Dr. John R. Moser, Treasurer Dr. Jeff Nehring, Region 1 Dr. Pete Hehli, Region 2 Dr. Thomas Raimann, Region 3 Dr. Cliff Hartmann, Region 4 Dr. Dave Clemens, Region 5 Staff liaison: Mark Paget, 800-364-7646 x4100 Finance Committee (annual) Dr. John R. Moser, Treasurer, Chair Dr. Julio Rodriguez, President elect, Co-Vice Chair Dr. Stan Brysh, Region 5, Co-Vice Chair Dr. Dave Kenyon, Region 1 Dr. Paul Feit, Region 2 Dr. Thomas Kielma, Region 3 Dr. Ned Murphy, Region 4 Dr. Timothy Durtsche, President Dr. Paul Levine, Vice President Dr. Steve Stoll, Immediate Past-President Staff liaison: Kelly Sics, 800-364-7646 x4102 House Nominating Committee (annual) Dr. Jodi Slominsky, Chair, Region 1 Dr. Martin Williams, Region 2 Dr. Russ Dunkel, Region 3 Dr. H. Michael Kaske, Region 4 Dr. Randy Ballweg, Region 5 Staff liaison: Mark Paget, 800-364-7646 x4100 House Nominating Committee Alternates (annual) Dr. Rick Mueller, Region 1 Dr. Ed Polzin, Region 2 Dr. Chan Tran, Region 3 Dr. Renita Burrell, Region 4 Dr. Allison Dowd, 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 (’13) Dr. Joseph Best (’14) Dr. Russell Christian (’14) Dr. Dave Clemens (’15) Dr. Timothy Cooper (’16) Dr. Eva Dahl (’16) Dr. Nicolet De Rose (’15) Dr. Dennis Engel (’14) Dr. Paul Hagemann (’13) Dr. Chris Hansen (’13) Dr. David Harry (’14) Dr. Monica Hebl (’13) 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) Dean William Lobb (MUSOD Dean) 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 (’13) Dr. James Springborn (’13) Dr. Barrett Straub (’13) Mr. Andrew Welles (MUSOD Student) Staff liaison: Mara Brooks, 888-538-8932 Long Range Planning Committee (2 yr/trustees) Dr. Timothy Durtsche, President, Chair Dr. Julio Rodriguez, President-Elect Dr. Paul Levine, Vice President Dr. Steve Stoll, Immediate Past-President Dr. John R. Moser, Treasurer Dr. Robert Brennan, Editor Dr. Jennifer Peglow, Region 1 (’14) Dr. Jeff Kraig, Region 2 (’13) Dr. Lynn Lepak-McSorley, Region 3 (’14) Dr. Ryan Braden, Region 4 (’13) Dr. Patrick Tepe, Region 5 (’14) 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 Dr. Paul Levine Consultant: Kris Anderson, 800-364-7646 x4120

WDA Committees Public Relations Committee (3 yr) Dr. Carl Meyers, Chair (’14) Dr. Thor Anderson (’15) Dr. Robert Brennan, Editor Dr. Ryan Dulde (‘15) Dr. Mike Grady (’14) Dr. Megan Heitke (’14) Ms. Beth Hettwer, RDH (‘15) Dr. Bill Horton (’14) Dr. Pat McConnell (’13) Dr. Sandra Piefer-Tomczak (’13) Dr. Kate Ratliff (’14) Dr. Jeff Kraig (Board Liaison)

Public Relations Committee (cont.)

Staff liaison: Carol Weber, 800-364-7646 x4108

AFFILIATED GROUPS

Mission of Mercy Committee (cont.)

Mr. Paul Batley Ms. Deb Beres, RDH Ms. Heidi Gaertner, RDH Mr. Kevin Greene (MUSOD) Ms. Colleen Krueger, RDH Ms. Annie Maslowski, RDH Ms. Cheri Meyer, RDH Ms. Colleen Pittner Mr. Dave Zanon, CDT 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. Julie Fox Dr. Scott Johnson Dept of Public Health Representative 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

WDA Insurance & Services Corp. Board (3yr) Dr. Jeff Kraig, Chair (’13) Dr. Ryan Braden, Vice Chair (’13) Dr. Josephine Chianello-Berman, At Large (’15) Dr. Mark Crego, At Large (’15) Dr. John R. Moser, WDA Treasurer (’13) Dr. Julio Rodriguez (’13) Mr. Peter R. Bray, CPA, At Large (’14) Mr. Mark Paget, Secretary Ms. Mara Roberts, WDAISC President 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, Vice Chair Dr. Robert Dillman, 2013 Local Co-Chair Ms. Judy Johnson, 2013 Local Co-Chair Dr. Zach Graf, 2014 Local Chair Dr. Ryan Braden Dr. Mark Braden Dr. Michael Cahlamer Dr. Robert Darling Dr. Fred Eichmiller Dr. Ken Geiger Dr. Mike Grady Dr. Mark Huberty Dr. William Lobb Dr. James Morgenroth Dr. Jay Preston Dr. Laura Rammer Dr. Gene Shoemaker

Relief Committee (5 yr) Dr. Greg Killian, Chair (’14) Dr. Charles Nyberg(’15) Dr. London Cooper, Vice Chair (’17) Dr. Lynne Brock (’17) Dr. Charles Nyberg, Dr. Kelly West (’16) Staff liaison: Amy Landis, 800-364-7646 x4126 WDA Foundation, Inc. Board (3 yr) Dr. Anthony Sciascia, President Dr. Loren Swanson, Vice President Dr. Christine Tempas, Treasurer Dr. Paul Oberbreckling, Imm. Past President Mr. Mark Paget, Secretary Dr. Tim Cooper, Region 1 (’14) Dr. Julie Fox, Region 1 (’13) Dr. Peter Steinert, Region 2 (’14) Dr. James Van Miller, Region 2 (’13) Dr. James Morgenroth, Region 3 (’15) Dr. Ronald Stifter, Region 3 (’13) Dr. Susan Cable, Region 4 (’15) Dr. Francesca De Rose, Region 4 (’15) Dr. Robb Warren, Region 5 (’14) Mr. Paul Batley, Henry Schein Dental (’15) Mr. David C. Wagner, Schenck S.C. (’15) Ms. Jeanne Rude, At Large (’15) Dr. Roger Comeau (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 (’13) Dr. Tip Brown (’14) Dr. Dan Kujak (’13) Dr. Lisa Koenig (MUSOD) Dr. Lynn Lepak-McSorley (’13) Dr. Terry Miskulin (’14) Dr. Laura Rammer (’15) Dr. Majelle Susler (‘15) Dr. Ryan Braden (Board Liaison) Staff liaison: Amy Landis, 800-364-7646 x4126

Wisconsin Dental Political Action Committee (3 yr) Dr. Dave Clemens, Chair (’13) Dr. Pete Hehli, Vice Chair (’15) (Board Liaison) Dr. Timothy Cooper, Treasurer (’14) Dr. Monica Hebl, Secretary (’14) Dr. Ed Chiera (’15) Dr. Eva Dahl (’13) Dr. Dennis Engel (’13) Dr. Paul Hagemann (’13) Dr. Chris Hansen (’13) Dr. Fred Jaeger (’15) Dr. Jeff Jones (’14) Dr. H. Michael Kaske (’13) Dr. David Kenyon (’15) Dr. Mark Mueller (’13) Dr. Ned Murphy (’14) Dr. Julio Rodriguez (’13) Dr. James Springborn (’14) Dr. Barrett Straub (’13) Dr. Eric teDuits (LC Chair) Dr. Kent Vandehaar (’13) Staff liaison: Mara Brooks, 888-538-8932

2013 WDA Sourcebook

17

Important Contact Information

Important Contact Information

Business resources Americans with Disabilities Act The Americans 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: http://wisconsin.bbb.org/ CPR certification CPR Madison Phone: 608-772-5990 Website: http://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: http://foxvalleycpr.com WDA Professional Services Phone: 800-243-4675 or 414-276-3954 Fax: 414-276-2186 Website: www.dentalrecord.com

18

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 WDA Insurance Programs Phone: 800-242-9077 or 414-277-7727 Fax: 414-277-1124 Email: info@insuranceformember.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 Dean’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: erinn@dental-exp.com Website: http://dentalexpressstaffing.com

Wisconsin AIDS/HIV Program James Vergeront, M.D., Program Director Phone: 608-267-5287 Email: james.vergeront@wisconsin.gov

Dental Word of Mouth Contact: Wendy Durfee, RDH Phone: 401-397-0519 Email: Wendy@DentalWordofMouth.com Website: www.dentalwordofmouth.com

Hotlines Legislative Phone: 800-362-9472 or 608- 266-9960 Website: http://legis.wisconsin.gov

Mobile Medical Specialists Contact: Scott Stollenwerk Phone: 262-691-1000 Email: sstollenwerk@mobilemedicalspecialists.com

2013 WDA Sourcebook

On Assignment Health Care Staffing Contact: Jamie Baumann Phone: 414-257-9513 Email: jamie.baumann@onassignment.com Website: www.onassignment.com Redi Help Dental Contact: Tony Hains Phone: 414-727-7011 Email: tony@redihelp.net Website: http://redihelpdental.com Tripartite American Dental Association 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 Catalog Sales Phone: 800-947-4746 Website: http://catalog.ada.org Great-West Life and Disability Insurance/ADA Phone: 800-568-2001 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. Thomas Raimann 11801 W. Janesville Road Hales Corners WI 53130 Phone: 414-425-1510 Email: traimann@wda.org American College of Prosthodontists, WI Section Dr. David Kachelmeyer, President 5800 N. Bayshore Dr. #B262 Glendale, WI 53217 Phone: 414-332-7450 Fax: 414-332-2454 Email: david.kachelmeyere@mu.edu Website: www.wisconsinprosthodontists.com

International College of Dentists Dr. Christine Tempas 131 Cherry St. Sheboygan Falls, WI 53085 Phone: 920-467-4257 ctempas@intella.net

Wisconsin Dental Assistants Association MaLea Flynn, CDA, CDPMA 14284 Spring Creek Road Mountain, WI 54149-9713 Phone: 715-276-7369 Email: malea@centurytel.net

Madison Dental Progress Forum Dr. Gene Sorensen 216 S. Main St. Lodi, WI 53555 Phone: 608-592-4398 Email: lvdental@charterinternet.com

Wisconsin Dental Hygienists’ Association Sharri Crowe, RDH, BSDH, MS, President, 2011-2013 1825 N. Bluemound Drive Appleton, WI 54912 Phone: 920-735-2463 Email: crowe@fvtc.edu Website: www.wi-dha.com

Marquette University School of Dentistry PO Box 1881 Milwaukee, WI 53201-1881 General phone: 414-288-6500 Website: www.marquette.edu/dentistry Milwaukee Dental Hygiene Study Club Cristy Marsh, RDH 2933 W. Layton Ave. Greenfield, WI 53221 Phone: 414-282-2642 Fax: 414-282-1952 Email: hygiene@premierperio.com

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

Milwaukee Study Club Dr. Constantine Stamatelakys 2933 W. Layton Ave. Greenfield, WI 53221 Phone: 414-282-2642 Fax: 414-282-1952 Email: cs@premierperio.com

American Dental Association 9th District Trustee Dr. Dennis W. Engel 7604 W. Mequon Road Mequon, WI 53097 Phone: 262-242-8929 Fax: 262-242-9941 Email: engeld@ada.org

Pierre Fauchard Academy – WI 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

Dental Forum Dr. Jeffrey Keesler, President 1524 S. Commercial St. Neenah, WI 54956 Phone: 920-729-0889 Fax: 920-751-8584 Email: jeff@keeslerortho.com

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: http://wiagd.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

Wisconsin Association of Endodontists Dr. Kris Olsen Marquette University School of Dentistry - Department of Endodontics PO Box 1881 Milwaukee, WI 53201 Phone: 414-288-7047 Fax: 414-288-6510 Email: kris.olsen@mu.edu Website: www.aae.org

Related Organizations

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

Wisconsin Dental Study Club Dr. Stuart J. McCormick 5610 Monticello Way Fitchburg, WI 53719-1602 Phone: 608-233-5351 Fax: 608-238-6777 Website: http://wisconsindentalstudyclub.com Wisconsin Society of Oral & Maxillofacial Surgeons Roxanne Haberkorn, WSOMS Executive Secretary Phone: 920-887-8423 Fax: 920-887-8471 Email: roxanne@wsoms.net Website: www.wsoms.net Wisconsin Society of Orthodontists Karen Schneider 702 Eisenhower Drive, Suite A Kimberly, WI 54136 Phone: 920-560-5626 Fax: 920-882-3655 Email: Karen@badgerbaymanagement.com Wisconsin Society of Pediatric Dentists Dr. Thomas Turner PO Box 236 Wausau, WI 54402 Phone: 715-842-4649 Email: drturner@fidkids.com Website: http://wi-spd.org Wisconsin Society of Periodontists Dr. Edwin Schoenenberger 2316 N. Grandview Blvd.

Waukesha, WI 53188 Phone: 262-547-1877 Fax: 262-521-3476 Email: wergumz@gmail.com

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Dental Education Blackhawk Technical College Dental hygiene 6004 S. County Road G Janesville, WI 53546-9458 Phone: 608-758-6900 or 800-498-1282

Dental Education

Chippewa Valley Technical College Dental assisting and dental hygiene 620 W. Clairemont Ave. Eau Claire, WI 54701-1098 Phone: 800-547-2882 or 715-833-6346 Website: www.cvtc.edu Fox Valley Technical College Dental assisting and dental hygiene 1825 Bluemound Road PO Box 2277 Appleton, WI 54912-2277 Phone: 800-735-3882 or 920-735-5645 Website: www.fvtc.edu Gateway Technical College Dental assisting 3520 30th Ave. Kenosha, WI 53144 Phone: 262-564-2412 or 800-247-7122 Website: www.gtc.edu Lakeshore Technical College Dental assisting and dental hygiene 1290 North Ave. Cleveland, WI 53015-9761 Phone: 888-468-6582 or 920-693-1000 Website: www.gotoltc.edu Lake Superior College Dental hygiene 2101 Trinity Road Duluth, MN 55811 Phone: 218-733-7600 or 800-432-2884 Website: www.lsc.edu 20

2013 WDA Sourcebook

Madison Area Technical College Dental assisting and dental hygiene 3550 Anderson St. Madison, WI 53704-5599 Phone: 608-246-6065 or 800-322-6282 Website: www.matcmadison.edu Marquette University School of Dentistry Dentistry only 1801 W. Wisconsin Ave. PO Box 1881 Milwaukee, WI 53201-1881 Phone: 414-288-3093 (alumni office) 414-288-3532 (admissions) Website: www.marquette.edu/dentistry Milwaukee Area Technical College Dental assisting, dental hygiene and lab technician 700 W. Highland Ave. Milwaukee, WI 53233-1433 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 Dr. 54401-1899 Phone: 715-675-3331 Website: www.ntc.edu

Northeast Wisconsin Technical College Dental assisting and dental hygiene 2740 W. Mason St. PO Box 19042 Green Bay, WI 54307-9042 Phone: 800-422-6982, ext. 5444 or 920-498-5543 Website: www.nwtc.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 Waukesha County Technical College Dental assisting and dental hygiene 800 Main St. Pewaukee, WI 53072-4601 Phone: 262-691-5200 Website: www.wctc.edu

SERVE

Member Benefits and Resources

Member Benefits and Resources Member Benefits and Resources

Joining the Wisconsin Dental Association is one of the best investments you can make.

WDA members receive a host of benefits that make a difference in their practices and in their profession.

The WDA offers numerous benefits that are directly tied to association goals – Advocate, Educate, Empower and Serve.

These goals work toward our mission of advancing the interest of our members and the dental profession by promoting professional excellence and quality 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 much-needed dental care to Wisconsin families, as well as fostering a strong climate where locally owned, smallbusiness 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: • Removal of dental health maintenance organizations from southeastern counties • Increased Medicaid reimbursement pilot project • Meaningful loan forgiveness program • Comprehensive patient education program • Expanded Function Dental Auxiliary Healthy choices E-lert – Publication sent periodically to state legislators, policymakers and anyone else who wishes to receive reviews of important oral health invitiatves being discussed in Madison.

Community water fluoridation – Community water fluoridation helps all Wisconsin residents, regardless of age or economic status, maintain good oral health. The WDA

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2013 WDA Sourcebook

works collaboratively with state agencies, oral health advocacy organizations, local health departments and member dentists 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 in 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 initiate its multi-phase, multi-year effort to educate dentists (Dental Home) and the public (Baby Teeth Matter – see page 23) about early childhood dental health in 2008.

Dental home continuing education materials have been developed to help general dentists and their dental teams become comfortable with examining and treating young children.

These materials, including an instructional video and supporting written materials are available to members on WDA.org (login required).

Give Kids A Smile® – In 2013, an estimated 330 Wisconsin dentists and 230 dental hygienists, along with 530 other team members, dental, hygiene and assisting students, faculty and

Member Benefits and Resources community advocates volunteered their time and skills to get underserved children out of dental pain. Since 2003, dentists statewide have donated more than $7.2 million in care to more than 49,900 low-income children.

Learn more about GKAS® and sign up for email updates on www.wda.org/dental-professional/gkas.

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

The WDA and WDA Foundation Mission of Mercy marks five years in 2013. 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.

On average, $6 to $8 in care is provided for every one dollar donated. More than 8,600 people have received $4.6 million in donated care at WDA Mission of Mercy events since 2009.

MOM volunteers will travel to Walworth County on June 28 and 29, 2013.

See page 29 for more information.

Contact WDA Associate Executive Director Lani Becker at lbecker@wda.org or 414-755-4114 for more information or visit 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.

A 2009 statewide public survey showed 79 percent of Wisconsin residents had heard of or were familiar with the WDA, compared to less than 20 percent when first tracked in the early 1990s.

Member Benefits and Resources

GKAS® e-Update offers tips for in-office, group or componentwide events and classroom presentations. It also 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.

Public awareness – Public awareness campaigns educate the public, policymakers, media, member dentists and dental teams about important oral health issues, while building awareness of dentistry and the WDA.

• “Baby Teeth Matter” educates parents and caregivers about the importance of baby or primary teeth to a child’s early physical, social and emotional development.

• “Back-to-Basics” promotes the affordability and value of preventive dental care.

• “Brush & Floss or Else…” is an ongoing, multi-topic dental health education program about the impact of oral health on overall well-being.

• “Sip All Day, Get Decay” educates the public about the dangers of excessive soft drink consumption and the important roles nutrition and prevention play in maintaining good oral health.

• “Healthy Choices – The Right Path to Better Oral Health – and Better Overall Health – for Wisconsin” seeks to build legislative and public support for WDA’s access solutions by emphasizing how patients benefit when they receive important oral health prevention and treatment in a timely manner in a dental home.

Contact WDA Director of Public Relations 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.

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) and distributed to members with the WDA Journal. It is suggested that dentists display it in their practice reception areas and dental hygienists use it with chair-side discussions.

Everyone – members, patients, family, friends, colleagues, general public, media – are invited to “subscribe” on WDA. org to the electronic version which is issued four times a year (winter, spring, summer and fall).

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Member Benefits and Resources

EMPOWER 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.

Member Benefits and Resources

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.

WDA Component Connection – A quarterly e-newsletter sent to all component officers to share best practices and provide tools and resources to help manage, operate and lead dental societies.

Contact WDA Member Relations Coordinator Amy Landis at 800-364-7646 (toll-free), 414-755-4126 (direct) or alandis@wda.org for component support.

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 Dental Practice Act, administrative rules and frequently asked practice and legal questions.

The print edition is mailed in early spring. The WDA Sourcebook is also available on WDA.org (member login required) as a downloadable PDF and a digitial-flip format.

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

WDA

WISCONSIN DENTAL ASSOCIATION

WIDPAC – By contributing to the Wisconsin Dental Political Action Committee (WIDPAC, Direct Giver, American Dental Political Action 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 WDA website provides oral health information for patients and the general public.

The goal of Legislative Day is to help dentists and dental students become comfortable communicating dentistry’s message to elected officials of both political parties. Help support WDA’s image as the “Tooth Party” whose members advance issues that promote professional excellence and quality oral health care for the public. Dentists from across the Badger State will gather in Madison to hear from a panel of guest speakers, ask questions and visit legislators in their Capitol offices.

Recognized as a go-to source for oral health information and dental issues by members, their patients and the public, WDA.org is a helpful 24/7 resource.

SERVE 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 the Government Buzz, Business of Dentistry section and Calendar of Events which includes continuing education offerings.

Classified advertising is available at special member rates with seven categories, including practice position opportunities, practices for sale/lease and equipment for sale.

In addition to the mid-month mailing of this publication, every issue of the WDA Journal is posted on WDA.org as a downloadable PDF and in an electronic “flip” format.

Member login required.

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2013 WDA Sourcebook

Here, too, WDA dentist and dental hygienist members can find 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.

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.

Social networking poses a brave, new, 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.

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 photos of colleagues and friends on Flickr.

Check out the WDA on Pinterest for dental-related photos.

Follow the WDA on LinkedIn to connect with WDA member dentists and dental hygienists and other dental professionals.

Member Benefits and Resources

The WDA Executive Director’s Update is emailed to dentist and dental hygienist members on the last business day of every month. It offers late-breaking association, dental-related regulation and compliance, legislative and community news.

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 wellbeing 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 addictions, depression, infectious diseases and other well-being issues.

See page 30 for more information or learn more at WDA.org.

InSession Meet with colleagues from throughout the state at WDA InSession – Wisconsin’s Largest Dental Study Club for informative continuing education lectures and interactive learning sessions. Take advantage of excellent support from exhibitors who bring the latest in dental technology. See page 21 for more “Hear.See.Do.” information or visit WDA.org.

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.

Visit WDA.org to learn more or contact WDA Mediation Services Consultant 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. Recipients are recognized in conjunction with the annual WDA House of Delegates meeting every fall.

Recognition categories include: Recognize a • Lifetime Achievement colleague, member • Community Outreach friend for their ou or • WDA Foundation Philanthropic ts contribution to dent tanding • Friends of Dentistry istry See page 102 !

• Media Relations for details.

• Media Awareness • New Dentist Leadership • Outstanding Leadership in Mentoring • Political Action • WDA Award of Honor Nomination deadline is Monday, July 15, 2013. See page 102 for the 2013 POP nomination form.

Contact WDA Member Relations Coordinator Amy Landis at alandis@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 into 20 endorsed programs to save money on dental office essentials, products, services and more.

See pages 98-99 for more information.

WDA Insurance Programs – Take advantage of group medical insurance available to members and their staffs.

WDA-endorsed liability, property, life, disability overhead and personal lines insurance plans are also available. These products and more are available through WDAIP – a fullservice insurance agency for the dental profession. See page 100 for more information.

Mediation Services – A long-standing service of the WDA, Peer Review was initially offered as a way for patients and dentists to resolve differences without the expense of the legal system or going before the Dental Examining Board.

The program has been renamed Mediation Services to better represent the process and reflect the WDA’s impartial role as “middle man”. Every effort is made to treat both sides fairly throughout the disagreement.

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Member Benefits and Resources

Make sure you’re getting 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.

Trained mediation services volunteer dentists (generalists and specialists) base their decisions and recommendations on careful review of evidence provided and reached in a fair and objective manner.

Member Get A Member

Building the future of our profession … together!

Share why you belong to the #1 organization representing all dentists.

As an active member, you know first-hand the value of a strong ADA — greater recognition for the profession, more resources for members, and a louder voice in Washington and across the country.

Most ADA members say they would recommend membership to colleagues. Now, here’s your chance!

ADA Member-Get-A-Member Any ADA member dentist is eligible to participate in the 2013 ADA Member-Get-A-Member Campaign.

With your help: • The ADA benefits by being able to represent another member dentist.

• The new member you recruit benefits by taking advantage of all membership has to offer.

• You benefit by strengthening the ADA and sharing the value of membership with another colleague — plus there are incentives and prizes for recruiters! For details visit ADA.org/MGAM. Recruiting is Rewarding You will be rewarded with a $100 American Express gift card for each new, active member you recruit (up to five members or $500 in American Express gift cards)! Or you may decline the incentive and ADA will contribute $100 to the ADA Foundation. Please see Campaign Rules for full details at ADA.org/MGAM. Participate in the 2013 Member-Get-a-Member Campaign and help build the future of our profession!

Don’t Delay! The ADA Member-Get-A-Member campaign runs through September 30, 2013. For resources to assist your recruiting efforts, plus complete guidelines and rules visit ADA.org/MGAM, send an email to mgam@ada.org or call the ADA Member Service Center at 800.621.8099.

Mentor Program

Mentor Program The Mentor Program organized by Wisconsin Dental Association, Marquette University School of Dentistry and the Pierre Fauchard Academy 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:

• Networking with colleagues • Working through problem-solving • Gaining new perspectives • Sharing expertise • Giving back to the profession • Helping develop the profession’s future • Staying apprised of changes in dental education

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

Mark your calendars!

Future Mentor Program kick-off dinners Sept. 30, 2013 and Sept. 29, 2014.

“I have been inspired by the energy of more experienced dentists than myself and I am excited to pass that on by sharing

“It has been a refreshing opportunity to be a part of the forma-

my passion for such a wonderful profession.”

tion of young practitioners. Things that are taken for granted

Dr. Megan Heitke (Milwaukee)

are realized as challenges for my young counterparts. It has been and continues to be self fulfilling and extremely appreciated,” Dr. Glenn Gequillana (Milwaukee)

“Mentorship is rewarding and fun! It keeps you connected with the dental school and helps you realize how far you have come in your career and how much there is still to learn.”

Dr. Angela Lueck (Milwaukee)

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WDA Foundation

As the philanthropic arm of the Wisconsin Dental Association, 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 via the Internet on 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 Recycle items at Action Recyclers in Milwaukee Support foundation special events, including the silent auction at InSession and the annual golf outing

Contact WDA Foundation Executive Director Vicki Bohman at vbohman@wda.org or 414-755-4198 or visit 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.

Putting for a Purpose – Mark your calendar!

The Wisconsin State Dental Golf Tournament is set for Monday, Sept. 9, 2013 at North Hills Country Club in Menomonee Falls.

Proceeds from the event benefit the WDA Foundation.

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Mission of Mercy EDUCATE

Mission of Mercy 2013 on June 28 and 29 in Walworth County 2013 MOM goals Mission of Mercy

Provide $1 million in charitable dental care Log 2,000 patient visits Recruit 1,000 dental and community volunteers

The Wisconsin Dental Association and WDA Foundation will team up for their fifth Mission of Mercy at Badger High School in Lake Geneva* on Friday, June 28 and Saturday, June 29. (Setup is Thursday, June 27 and teardown is Sunday, June 30.)

Treatment offered will include diagnosis by a dentist; fillings; extractions; limited, front-teeth transitional partials; and cleanings. *Some have questioned why Lake Geneva, a resort area, was selected for MOM 2013. The need is great, as many of the year-round residents work in the service industry for minimum wage or just slightly more. Walworth County and the surrounding area have also taken some major economic hits leaving significant need for dental care. Lake Geneva is proving to be a very supportive host community and is contributing cash and in-kind donations to MOM.

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 volunteers, including 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 to for more information and to register, or contact WDA Associate Executive Director Lani Becker at lbecker@wda.org or 414-755-4114.

SAVE THE DATE! MOM 2014

June 27 and 28 KI Center in Green Bay

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.

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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.

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

WDA Foundation Programs

• •

• •

Started in 1998, DDS has been delivering needed dental care for 15 years More than 2,765 disabled, elderly and medically compromised people have been treated $7.6 million in free, comprehensive treatment has been donated 780 Wisconsin dentists and 150 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, WDA Insurances and Services Corp. and the Pierre Fauchard Academy Foundation.

Become a DDS volunteer

2013 DDS patient waiting list This list represents the 10 counties in Wisconsin with the greatest need for additional Donated Dental Services volunteers.

County

How many months a recipient has been waiting

Douglas County ...................................72 months Pierce County ......................................48 months Washburn County ................................34 months Marinette County .................................30 months Fond du Lac County .............................30 months Racine County.......................................30 months Juneau County .....................................29 months Rock County ........................................28 months Sheboygan County ..............................28 months Walworth County ................................28 months

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 central and northern Wisconsin

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.

Grant 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 Amy Landis at alandis@ wda.org or 414-755-4126 for more information or to apply.

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WDA Bylaws

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 Officers..............................................................39

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

Chapter VI - Appointive Officers........................................................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

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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 non-profit 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 “The Wisconsin Non-stock Corporation Law.�

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 3rd 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.

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. 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.

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.

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. 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.

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 January 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 “House�), 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. 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.

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. 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.

2. Privileges. A retired member in good standing shall have the same rights and privileges as an active member.

3. Dues. The dues for affiliate members shall be established annually by the House and shall be due on January 1 of each year.

G. Provisional.

1. Qualifications. Provisional membership shall terminate December 31 of the calendar year following the year of graduation. To be a provisional member, a dentist:

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.

WDA Bylaws

Section 20. Qualifications.

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

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 c. Shall have applied for provisional membership within twelve months of graduation.

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WDA Bylaws 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.

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

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

WDA Bylaws

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 January 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 January 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 twenty-five (25) percent of the active membership dues as established annually by the House and due on January 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.

2. Privileges. A state public health member shall receive an annual evidence of member-

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ship, 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 this classification shall be twenty-five (25) percent of the active membership dues as established annually by the House and shall be due on January 1 of each year.

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.

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 (3) 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.

B. Right of Appeal.

1. Board of Trustees. Either the complaining party or the charged party may appeal any action

WDA Bylaws 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.

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.

Any appeal to the Board of Trustees shall be considered by the Board at its next regular or special meeting.

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.

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 thirty (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 fifteen (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 thirty (30) days after their adoption or amendment. For good cause, and after hearing, of which there has been written notice of not less than thirty (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 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.

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 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.

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.

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 ten 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 thirty-first 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 fifty (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 ninety (90) days prior to 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. Prior to such meeting of the House, the executive director shall prepare 2013 WDA Sourcebook

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WDA Bylaws 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 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 junior or senior engaged in clinical training and the students selected as alternates shall be from the sophomore or freshmen class at the time of such House meeting. 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.

WDA Bylaws

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:

In the event a duly elected regional Delegate to the American Dental Association House of Delegates is unable to serve, the WDA President-Elect, in consultation with the respective region’s trustees, shall appoint a person from that same region to fill the vacancy. If the respective region’s trustees cannot find a qualified replacement delegate from their region, the WDA President-Elect shall use his/her discretion to appoint the replacement delegate.

In the event a duly elected at-large delegate to the American Dental Association House of Delegates is unable to serve, the Alternate Delegate with the highest number of votes will fill that position. The then vacant alternate position will be filled by appointment by the WDA President-Elect.

In the event a duly elected Alternate Delegate to the American Dental Association House of Delegates is unable to serve, the position will be filled by appointment by the WDA President-Elect.

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.

A. Determine the legislative policies of this Association. It may act upon resolutions submitted by component societies or by not less than five (5) active members.

H. Elect an Ethics and Dental Relations Committee.

B. Enact, amend, or repeal the Bylaws of the Association as provided in Chapter XIII hereof.

I. Elect a Nominating Committee as outlined in Section 80 of this Chapter III.

E. Create Special committees.

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.

F. Approve memorials in the name of the Association.

A. Bylaws

G. Adopt or amend the annual budget for the ensuing year proposed by the Board of Trustees.

1. Composition. The committee shall be composed of five (5) 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.

C. Grant, amend, or revoke charters of component societies.

D. Elect honorary members.

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 (5) 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 (2) 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. 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. 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

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shall be an automatic delegate. The Dean of Marquette University School of Dentistry shall be an automatic alternate.

2013 WDA Sourcebook

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 (9) members; five (5) members shall be elected by the trustee regions (one from each trustee region) for terms of three (3) years on a rotating basis, their election confirmed by the House; three (3) members shall be elected by the House as at-large members for terms of three (3) years. One (1) 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.

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.

WDA Bylaws 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.

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.

C. Nominating.

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 fourteen (14) days in advance of the House.

1. Composition. The committee shall be composed of five (5) members and five (5) 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.

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.

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 (1) 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 forty-five (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 thirty (30) days before the opening meeting of any such session.

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.

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.

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. 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.

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 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 (3) 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 (3) trustees from each trustee region with the exception of the Student region, which shall consist of one (1) 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. 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. The absence of a trustee from a meeting of the Board of Trustees shall not in itself constitute a vacancy.

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 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 thirty (30), but not more than sixty (60), days in advance by e-mail, 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 (3) 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 (3) year term. Election to fulfill an unexpired term does not preclude serving two (2) full three (3) year terms. 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. A trustee region may elect trustees to terms of less than three (3) years in order to provide for such staggering of terms, and election to such partial term does not preclude serving 2013 WDA Sourcebook

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WDA Bylaws

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.

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.

WDA Bylaws two (2) full three (3) 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.

WDA 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.

K. Nominate and elect members of the Board of Directors of WDA Insurance & Services Corp.

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.

L. Direct the president in voting the shares of stock of WDA Insurance & Services Corp.

Section 70. Powers and Duties.

Powers. The Board of Trustees shall have the authority consistent with its responsibilities.

This shall include the power to:

O. Confirm the ADA 9th District Trustee-elect candidate elected by the Michigan Dental Association.

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.

F. Elect an Editorial Advisory Board, if it deems necessary.

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.

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

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

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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.

2013 WDA Sourcebook

M. Act as the appellate body for the state Ethics and Dental Relations Committee’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.

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 (5) 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 (9) 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, five (5) trustees, one from each trustee region, elected for a one (1) year term by the Board of Trustees, and the executive director, ex-officio. The treasurer 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.

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 thirty (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, president-

WDA Bylaws elect, past president, vice-president, treasurer, editor and five (5) trustees, one from each trustee region, elected for a one-year term by the Board of Trustees. The president serves as chairman.

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. Every three years, 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). EAB members provide the dentist and grassroots perspective for WDA print and electronic publications.

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

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

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.

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.

WDA Bylaws

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.

Region 6 – Student Region Marquette University School of Dentistry ASDA Chapter

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 (1) year.

The term of the Editor shall be four (4) 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.

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 2013 WDA Sourcebook

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WDA Bylaws 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; appoint the Board of Trustees Nominating Committee members at the Summer Board meeting and make appointments to the committees during term as president.

WDA Bylaws

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 Meeting as a delegate.

D. Editor. Shall be the editor-in-chief of the JOURNAL of the Association and shall have oversight responsibilities for WDA.org, the WDA Sourcebook, and the WDA Executive Director’s Update.

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.

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 - COMMITTIEES 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

5. Acting as custodian of the seal, records, books, and papers of the Board of Trustees and the House, and of all other documents and property belonging to the Association, unless otherwise specifically provided for.

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.

6. Performing all other duties prescribed for the office by these Bylaws, or by the House or Board of Trustees.

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 sixty (60) days prior to the time selected for the session.

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.

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9. Acting as executive editor of the JOURNAL of the Association.

2013 WDA Sourcebook

Section 30. Management and General Arrangements.

The Committee on the Annual Session shall provide for the management of, and make all

WDA Bylaws arrangements for, each scientific session not otherwise provided for in these Bylaws, subject to review by the Board of Trustees.

Section 20. Fiscal Year.

The fiscal year of this Association shall begin January 1 and end December 31.

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.

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.

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.

CHAPTER IX - SPECIAL MEETINGS OF THE 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 thirty (30) days prior to the date fixed for such meeting.

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. The Board of Trustees shall determine its size and the frequency of publication.

CHAPTER XI - FINANCES 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 January 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 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.

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 December 15 preceding the dues year, January 15, February 15, March 15, April 15 and May 15 of the current year. Partial payments of dues are not refundable.

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.

WDA Bylaws

Section 10. Quorum.

A quorum for a special meeting of the membership shall consist of 20 percent of the then current membership.

CHAPTER XII - INDEMNIFICATION OF OFFICERS, TRUSTEES, EMPLOYEES, AGENTS AND COMMITTEE MEMBERS

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.

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.

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.

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WDA Bylaws 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.

WDA Bylaws

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.

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.

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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 Sturgis Rules of Order, 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.

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.

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.

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.

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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.

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.

Code of Ethics

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.

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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.

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.

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.

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.

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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.

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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*.

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.

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.

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.

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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.

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.

Code of Ethics

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

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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).

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WDA Political Action Team EMPOWER

WDA

WDA Political Action Team

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.

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 dentalrelated 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.

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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 and/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.

WDA Political Action

• • • • • • • • • •

Become a member

• By mail - Photocopy this page, complete the information on below and send with personal check(s) or credit card info to: WDA, 10 East Doty St., Suite 509, Madison, WI 53703.

Team

Membership 2013

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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.

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

• 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.

Contacting your Legislators

Educate legislators about your dental practice

• 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.

Other ways to get involved 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.

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

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

WISCONSIN MEMBERS OF CONGRESS

Wisconsin Legislators

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, DC 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: 1 Russell Courtyard Office: 386 Russell 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, Rick (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, DC 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 Email: Sen.[last name]@legis.wisconsin.gov Superintendent Public Instruction Tony Evers 7841 266-1771 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 Senate State Capitol • Madison, WI 53707

Telephone Office (608) Leadership (Party)

President Michael Ellis (R-Neenah) 220-S 266-0718 President Pro Tempore Joseph Leibham (R-Sheboygan) 15-S 266-2056 Majority Leader Scott Fitzgerald (R-Juneau) 211-S 266-5660 Assistant Leader Glenn Grothman (R- West Bend) 10-S 266-7513 Minority Leader Chris Larson (D-Milwaukee) 206-S 266-7505 Assistant Leader Dave Hansen (D-Green Bay) 106-S 266-5670 Chief Clerk Jeffrey Renk B20-SE 266-2517 Sergeant-At-Arms Edward A. Blazel B35S-C 266-1801

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Wisconsin State Assembly State Capitol • Madison, WI 53702

Telephone Leadership (Party) Office (608)

Speaker Robin Vos (R-Burlington) 211-W 266-9171 Speaker Pro Tempore Bill Kramer (R-Waukesha) 103-W 266-858 Majority Leader Scott Suder (R-Abbotsford) 115-W 267-0280 Assistant Leader Jim Steineke (R-Kaukauna) 204-N 266-2418 Minority Leader Peter Barca (D-Kenosha) 201-W 266-5504 Assistant Leader Sandy Pasch (D-Shorewood) 119-N 266-7671 Chief Clerk Patrick Fuller 401-RJC 266-1501 Sergeant-At-Arms Anne Tonnon Byers 411-W 266-1503 Key to all legislative offices: E, W, N, S=Wings in Capitol Building, (RJC) Risser Justice Center=17 W. Main St.

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 266-0610 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 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

Dist. Office *Rep. (Party/Hometown)

Petersen, Kevin (R-Waupaca) 40 105-W 93 306-N Petryk, Warren (R-Eleva) Pope, Sondy (D-Cross Plains) 80 111-N 22 318-N Pridemore, Don (R-Hartford) Richards, Jon (D-Milwaukee) 19 118-N Riemer, Daniel (D-Milwaukee) 7 409-N 45 321-W Ringhand, Janis (D-Evansville) Ripp, Keith (R-Lodi) 42 223-N 15 21-N Sanfelippo, Joe (R-West Allis) Sargent, Melissa (D-Madison) 48 8-W Schraa, Michael (R-Oshkosh) 53 22-W 28 221-N Severson, Erik (R-Star Prairie) Shankland, Katrina (D-Stevens Point) 71 418-N 20 114-N Sinicki, Christine (D-Milwaukee) Smith, Stephen (D-Shell Lake) 75 4-W Spiros, John (R-Marshfield) 86 17-N 5 204-N Steineke, Jim (R-Kaukauna) Stone, Jeff (R-Greendale) 82 314-N 58 324-E Strachota, Patricia (R-West Bend) Strobel, Duey (R-Saukville) 60 207-N Suder, Scott (R-Abbotsford) 69 115-W Swearingen, Rob (R-Rhinelander) 34 19-N 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 21-N Tranel, Travis (R-Cuba City) 49 308-N Vos, Robin (R-Burlington) 63 211-W Vruwink, Amy Sue (D-Milladore) 70 112-N Wachs, Dana (D-Eau Claire) 91 302-N Weatherson 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 266-0620 266-0960 267-7990 267-2365 267-9649 266-8588 266-2519 266-1182 266-2418 266-8590 264-8486 267-0820 267-2418 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) 68 107-W 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 Honadel, Mark (R-South Milwaukee) 21 113-W 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) 61 315-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) 97 103-W Krug, Scott (R-Nekoosa) 72 208-N Kuglitsch, Mike (R-New Berlin) 84 129-W 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 18-N 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) 98 121-W 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 Vacant 98

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 State legislative website • www.legis.state.wi.us U.S. Senate website • www.senate.gov U.S. House of Representatives website www.house.gov

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Government Agencies

Government agencies that impact dentistry STATE Department of Health Services 608-266-1865 www.dhs.wisconsin.gov Dental Medicaid Information www.dhs.wisconsin.gov/medicaid/index.htm Division of Health Care Access and Accountability Dental Consultant (Dr. Robert Dwyer) 608-264-6754 Robert.Dwyer@wisconsin.gov

Government Agencies

Division of Radiation Protection www.dhs.wisconsin.gov/radiation/Index.htm William Balke, x-Ray Supervisor 608-267-4787 William.balke@wisconsin.gov MA Provider Hotline 800-947-9627 www.forwardhealth.wi.gov MA Recipient Hotline 800-362-3002 Managed Care Services (Kenosha, Milwaukee, Ozaukee, Racine and Waukesha Counties) 608-266-7894

FEDERAL Centers for Disease Control and Prevention 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 877-696-6775 www.hhs.gov HIPAA General Information: Centers for Medicaid and Medicare Services www.cms.hhs.gov/HIPAAGenInfo/ Health Information Privacy: Office of Civil Rights – patient privacy and discrimination issues www.hhs.gov/ocr/privacy Health Resources and Services Administration – loan assistance and community funding programs www.hrsa.gov 56

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Division of Public Health 608-266-1251 www.dhs.wisconsin.gov/aboutdhs/dph/dph.htm Chief Dental Officer Dr. Jeffrey Chaffin 608-266-5152 Jeffrey.Chaffin@wisconsin.gov Robbyn Kuester, RDH Sealant and Fluoridation Program Coordinator 608-266-0876 Robbyn.Kuester@wisconsin.gov Fluoride and other oral health fact sheets www.dhs.wisconsin.gov/health/Oral_Health/Fact Sheets.htm Department of Natural Resources – Bureau of Waste Management 608-266-2111 http://dnr.wi.gov DNR Guidelines (copy requests) 608-266-2111 Mercury Reduction Program http://dnr.wi.gov/org/caer/cea/mercury

Department of Labor 866-487-2365 Small Business Information www.dol.gov/elaws/ Drug Enforcement Administration www.justice.gov/dea Washington, DC 202-305-8500 Registration www.deadiversion.usdoj.gov/drugreg/ index.html#2 800-882-9539 Chicago 312-353-7875 Milwaukee (prescription drugs) 414-336-7300 Madison (illegal drugs) 608-264-5111 Food and Drug Administration 888-463-6332 www.fda.gov Dental Amalgam Information www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/DentalAmalgam/ default.htm

Department of Safety and Professional Services 608-266-2112 • 608-267-0644, Fax http://dsps.wi.gov/ Dentistry Examining Board Bureau Director - Vacant 608-266-8741 DSPSBoards@wisconsin.gov Legislative hotline

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800-362-9472

Department of Workforce Development 608-266-3131 http://dwd.wisconsin.gov Division of Worker’s Compensation 608-266-1340 • 608-267-0394, Fax Employer Poster Requirements http://dwd.wisconsin.gov/dwd/posters.htm Office of the Commissioner of Insurance 608-266-3585 • 800-236-8517 608-266-9935, Fax www.oci.wi.gov Complaints and Information 608-266-3585 Toll-free 800-236-8517 ocicomplaints@wisconsin.gov

National Institutes of Health 301-496-4000 www.nih.gov National Institute of Dental and Craniofacial Research www.nidcr.nih.gov Occupational Safety and Health Administration 800-321-6742 www.osha.gov WDA resource: Bloodborne Pathogens Guidelines for Dental Offices www.wda.org OSHA and Dentistry www.osha.gov/SLTC/dentistry/index.html Appleton Chicago

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Eau Claire Madison

920-734-4521

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312-353-2220 715-832-9019

• •

Milwaukee

608-441-5388 •

414-297-3315

WDA Legislative Priorities

Wisconsin Dental Association legislative priority listing for 2013-14 session (Updated March 6, 2013)

HIGH PRIORITY The WDA will actively pursue meetings and necessary activities relating to the following designated “high priority items”.

Non-Covered Services Legislation (2011 AB 251/SB 186/SB 594) – PPursue passage of legislation prohibiting dental benefit plans from setting fees for services that are not reimbursed by the benefit plan.

Assembly bill 251 failed to pass the Legislature prior to adjournment in spring 2012. This will be slightly altered and then reintroduced as a new bill in the 2013-14 legislative session.

Status: The bill is currently in drafting as we have been working on replacing the previous «50 percent» clause with a general «de minimis» clause and are working with American Dental Association on ideal «de minimis» language.

We are also beginning a dialogue with the insurance companies regarding their concerns and will see what they say and whether we can agree to reach a compromise in which they will go «neutral» if we make some changes to the bill.

The new lead senate author is state Sen. Jerry Petrowski (R-Marathon) and lead assembly author is state Rep. Joan Ballweg (R-Markesan).

There were 41 co-sponsors of this legislation last session and the WDA’s goal is to meet with most of the 132 state legislators between now and WDA Legislative Day on March 27, 2013 to increase the numbers of authors so that when the bill is introduced in mid-March, we can really have a lot of legislators sign on in support.

Preliminary discussions on bill referrals have also been had with leadership in both houses of the legislature.

Fiscal impact to the state: $0.

Definition of Dentistry (Scope of Practice) – The WDA successfully obtained DEB support for drafting legislation that updates Wisconsin’s current statutory definition of dentistry with the ADA definition of dentistry.

This change would delete the current rather lengthy procedure-based definition with language that would allow dentists (who are properly trained and educated through continuing education courses or other training methods) to offer new effective oral health treatment modalities and services to patients based on the latest scientific and technological advances within the profession.

Status: Lead sponsors in both houses still need to be identified for the 2013-14 session; the bill is in drafting but legislators are hesitant to sign on without knowing where the Wisconsin Medical Society stands on the bill and preliminary discussions indicate they may have concerns.

The Wisconsin Medical Society has met with us to discuss potential issues that some specialty groups may have with this legislation given the «turf battles» that have unfolded between the oral surgeons and plastic surgeons in some of the other states where the ADA definition was adopted.

While they don’t have a formal position (and are waiting to take one until they can see the actual bill draft), the WDA will continue to communicate with the WMS once a bill draft is ready for introduction.

Fiscal impact to the state: Minimal DSPS administrative costs.

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.

WDA L egislative P riorities L isting

The entire legislative hearing process will have to start over from the beginning.

The WDA had previously included the Expanded Function Dental Auxiliary changes into this bill draft but will likely focus only on the definition of dentistry changes in the upcoming session.

Regulation of Mobile Dental Clinics – In fall 2012, the state Department of Health Services finalized and released 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.

Status: WOHC Steering Committee meeting in late January included this issue on their agenda. They promised to keep the WDA informed of any action they take and the timeline if they decide to pursue legislation.

Marquette University School of Dentistry –The WDA has offered to play a supportive role for two Marquette University School of Dentistry state budget priority issues during the 2013-14 budget session.

They 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.

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.Status: This was not included in the Governor’s budget bill that was released in February 2013. (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 and 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.

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.

Fiscal estimate: The cost to implement both of these recommendations would be as follows: • 2013-2014 Up to 170 Wisconsin residents at $11,670 per resident, per year is $1,983,900 ($597,500 over the base budget).

• 2014-2015 Up to 180 Wisconsin residents at $11,670 per resident, per year is $2,100,600 ($714,200 over the base budget).

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WDA Legislative Priorities • 2015-2016 Up to 190 Wisconsin residents at $11,670 per resident, per year is $2,217,300 ($830,900 over the base budget).

It is WDA’s strong desire to make sure any dentists who apply are actually willing to commit to attending all the meetings and being engaged in the proceedings.

• 2016-2017 Up to 200 Wisconsin residents at $11,670 per resident, per year is $2,334,000 ($947,600 over the base budget).

Status: WDA leadership and staff share background information on responsibilities of a DEB member with any individuals who have an interest in applying and serving.

The dentist seats opening in July 2013 will be the seats currently held by Drs. John Grignon, Kirk Ritchie and Adrianna Jaramillo who are all finishing their second term and are not eligible for a third term.

An alternative to this proposal would be to increase just the number of in-state residents eligible for the tuition subsidy from 40 to 50 per class, leaving the subsidy itself at the current rate of $8,665.

• 2013-2014 Up to 170 Wisconsin residents at $8,665 per resident, per year is $1,473,050 ($86,650 over the base budget).

• 2014-2015 Up to 180 Wisconsin residents at $8,665 per resident, per year is $1,559,700 ($173,300 over the base budget).

• 2015-2016 Up to 190 Wisconsin residents at $8,665 per resident, per year is $1,646,350 ($259,950 over the base budget).

• 2016-2017 Up to 200 Wisconsin residents at $8,665 per resident, per year is $1,733,000 ($346,600 over the base budget).

WDA L egislative P riorities L isting

Status: Gov. Scott Walker’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 of 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.

Assignment of Benefits/Direct Pay Legislation – Assignment of Benefits/”Direct Pay” legislation would require dental benefit plans toAssignment of Benefits/”Direct Pay” legislation would require dental benefit plans to honor a request from a covered individual who proactively seeks to direct the payment made by their dental benefit plan to a non-network dentist who rendered the service, as long as the plan currently reimburses 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. Insurance plans fought this legislation very hard (as did labor organizations) in the 2009-10 legislative session which was controlled by Democrats in both houses and the Governor was a Democrat. It is unlikely this legislation will have any chance of passage under a Republican controlled legislature and executive branch.

Status: Prior to the 2011-12 session, the WDA considered rolling this proposal in with the non-covered services legislation but given Delta Dental of Wisconsin’s strong opposition to this proposal and their willingness to go neutral on the non-covered services proposal, the WDA chose to advance the non-covered services bill instead of this proposal.

The WDA had previously belonged to a broad health care coalition that was formed in the 2009-10 legislative session to advance the passage of this legislation and make it applicable to all health plans and all providers. The coalition was not activated during the 2011-12 session and there appears to be no activity to start it up in 2013-14 either.

There have been inquiries by Democratic legislators as to whether or not they would like us to pursue this legislation this session.

It was mentioned in the meetings with insurance companies that the Republican-controlled Legislature is not going to allow both the NCS and a bill on AOB to go through in the same session.

Fiscal impact to the state: $0.

Appointments to the Dentistry Examining Board – There will be three board vacancies (all held by dentists) in July 2013 and the WDA will be active in providing input to the Governor’s office regarding names of dentists who have applied to serve as members on the DEB.

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The Governor’s office has indicated they will make these appointments in the spring 2013.

Fiscal impact to state: $0.

Dental Medicaid Program (Access) – (a) HMO Dental Medicaid - The WDA government services division has played a very active role 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.

Recent reports from United Health Care have indicated that they have made more than $600,000 in back-payments to dentists who had received less than fee-for-service rates between early 2012 and September 2012. The WDA has been, and remains, in favor of removing the HMOs from the delivery of dental Medicaid services in southeastern Wisconsin counties.

In summer 2012, one of the larger medical HMOs in this area (United Healthcare) announced its plans to leave the Medicaid business and the WDA worked hard to advocate for a transition to fee-for-service dentistry in these six counties; it appears that DHS will continue to advocate for HMO delivery in dentistry beyond the March 1, 2013 transition date in which all formerly enrolled (174,000) UHC enrollees will begin being automatically enrolled in one of the remaining Medicaid HMOs. Status: The state’s Medicaid reform has not included any removal of the HMOs from the dental care delivery system.

With the onset of the implementation of the Affordable Care Act, the state DHS has decided to chew off as little with regard to Medicaid reform as possible until some of the unknowns regarding Medicaid actually unfold. Fiscal estimate: 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. (b) Reimbursement Pilot - In the recent past, the WDA has offered support for a multicounty 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.

Status: State Reps. Eric Genrich (D-Green Bay) and Cory Mason (D-Racine) are looking to try and revitalize a local reimbursement pilot project in the budget cycle this session and are working with the Fiscal Bureau to obtain an estimate of what this might cost.

It was estimated in 2008 that a statewide increase to the 75 percentile (which means, on average, 75 percent of dentists making 100 percent of their rates based on the mostrecent ADA survey for this region of the country), using the most-recent fiscal estimate would cost the state at least $30 - $40 million in GPR annually (an updated estimate would be beneficial).

The state’s own fiscal estimate believes such an increase in funding would result in a 25 percent increase in the number of individuals receiving dental care in both years of the biennium (25 percent the first year and an additional 25 percent the second year for a net (compounded) increase of 56 percent over the biennium).

The review on this issue is at a very preliminary stage but the WDA remains open to supporting this issue. (c) Emergency Room Dental Medicaid Pilot - In addition, the WDA would be supportive of a pilot program that would attempt to divert patients from emergency rooms while helping

WDA Legislative Priorities 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.

Status: The financial data we have been able to obtain from the hospital systems in Door County have not shown there is enough money being paid to the hospitals who see dental patients in the emergency room to help increase rates for dental care services should those patients first be diverted to the dental clinics.

The only argument we have in favor of setting up a pilot to increase rates in a diversion system is that the patients will be getting definitive care earlier in the health care process.

Fiscal Estimate: 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.

Expanded Delegation Legislation (Workforce/Access) –In the 2011-12 session, WDA was working on proposing 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 & 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. Status: The WDA is not actively pursuing this bill draft due to a great deal questions and concerns among member dentists who confuse the EFDA model with the mid-level provider model (MLPs often do irreversible procedures and not always under the supervision and diagnosis and treatment plan of a dentist).

Based on the feedback from the 2011 and 2012 WDA House of Delegates meeting and concerns issued by member dentists who are concerned about the reduction of quality care, this issue has been put on the back burner.

We also worked cooperatively with the WI Dental Assistants organization and the Wisconsin Dental Hygienists Association to reduce, as best as possible, the chances of this becoming a turf war. This was never introduced prior to the close of session.

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

Opposition to the Building of a Second Dental School – The WDA opposes 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

Furthermore, the state’s investment of $8 million for an expansion of the accredited dental school at Marquette 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.

Furthermore, 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.

Status: In late 2011 and early 2012, Marshfield successfully obtained $10 million of state funds (utilizing a $10 million matching grant from their own insurance plan) for a «dental educational outreach facility» which was first defined to be limited to dental residency training programs but which later morphed to include the concept of a second dental school (with up to 50 students per class).

The WDA remains opposed to a second dental school and believes it is a waste of taxpayer funds to create a separate institution that is not accredited and whose programs duplicate those of an existing institution.

WDA L egislative P riorities L isting

The Supply and Demand for Dental Services: Wisconsin 2010-2020 study released in January 2010 provided data that shows current access disparities in Wisconsin are related to lack of economic purchasing power among the low-income and MA population and not to the number of dentists in the state. As a result, the WDA continues to keep the Medicaid funding issue in front of policymakers, because by improving funding, the state empowers Medicaid patients to access dental care in a manner similar to the ways non-MA patients access care.

Fiscal Estimate: The WDA staff meetings every other month with the DHS Medicaid staff and continues to gather data and ask questions to gather information that will support a potential dental MA pilot project for the next state budget debate (2013-15).

recruitment and placement of dentists in rural areas and help even out the distribution of dentists in the state.

The WDA will continue to monitor Marshfield’s activity in building a second dental school and will ask Marshfield to provide written updates for our WDA Journal in order to keep our membership informed of the current status.

As of February 2013, it was reported that Marshfield is currently re-evaluating its decision to build a dental school due largely to the fact that the new rural medical college campus is going to be located in Wausau rather than Marshfield.

MUSOD and Marshfield have had preliminary discussions on how or whether they might be able to work together on the residency and post-baccalaureate programs that were also part of the original plan by Marshfield.

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.

Status: WDA has already heard from the Wisconsin Dental Hygienists’ Association about their desire to pursue legislation both on nitrous oxide administration and expanding the practice settings in which they can practice independent of a dentist.

The WDA will discuss their proposals at its February 2013 Board meeting

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.

Health Care Exchanges (Inclusion of Dental Coverage) – 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 will be 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.

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WDA Legislative Priorities Status: The WDA has been monitoring this activity at the state level but there remain questions and it is far from clear as to how the system(s) will unfold in Wisconsin. Delta Dental put together a one-page position paper on their concerns regarding the exchanges which the WDA has been in agreement with from a conceptual basis.

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 MA seen during the fifth year of service).

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).

Status: At the end of the 2011-12 session, state Rep. Sandy Pasch (D-Whitefish Bay) and state Sen. Dave Hansen (D-Green Bay) circulated a bill draft to their legislative colleagues that would implement these proposals and fund them partially with GPR ($40,000 from the existing dental state loan forgiveness program) and partially from Indian gambling revenues ($210,000) to get it through the first year of funding.

WDA L egislative P riorities L isting

State Rep. Pasch’s office has indicated that they are willing to pursue this legislation again this session.

The WDHA will be 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.

We would be supportive of the removal of the requirement that a patient is a patient of record of six months or more prior to receiving care by a dental hygienist without the dentist present.

It is unclear if removal of the six-month requirement is something that WDHA will pursue as part of their legislation.

Status: At the February 2013 Board of Trustees meeting, WDA President Dr. Tim Durtsche appointed a few members of the Board of Trustees to serve on a task force (staffed by Erika Valadez) to review potential educational requirements that would be necessary for a dental hygienist to become certified in the administration of nitrous oxide which would allow a dentist to delegate this procedure if the dentist remains on the premises.

Another potential alternative to have a positive impact on dental workforce recruitment is to remove the Medicaid service requirement from the current dental loan forgiveness program that exists in the state; the fiscal cost of removing the Medicaid requirement would be $0 but there could be an argument that fewer Medicaid people will be served if such a change is implemented. Unfortunately, with the extremely low dental Medicaid reimbursement rates, the mandatory Medicaid participation actually requires a dentist to absorb a net loss of $13,000 – this requirement removes the “incentive” any loan forgiveness offer may include.

The WDA will play a supportive, but not a leadership role in getting this legislation and rule-making passed.

The Pasch-Hansen bill was circulated for co-sponsors and there were 21 co-sponsors (2 Republicans and 19 Democrats).

Status: WDA is not currently participating in a legislative discussion or debate on this issue but is supportive of CODA-accredited dental residency programs that are established in both urban and rural underserved areas of the state.

The bill received a public hearing in the state Senate quite quickly but due to opposition from the medical society, the nursing association and the rural hospital association (all of whom opposed it because it separated dentists (and some funding) from the larger health care loan program that currently exists).

This support remains supportive regardless of whether these programs are offered by MUSOD or other Wisconsin institutions that have obtained CODA accreditation for their programs.

The Committee never took a vote on this proposal prior to the close of session which was due largely to the financial impact of the proposal and the negative reaction by the other health care provider groups.

“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 AB 237 or SB 117 which proposed a user fee charge of approximately two cents per 12-ounce can of soda.

Fiscal impact to the state: Once fully implemented (four or five years into the program) the cost would be $1 million in GPR each year.

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 payments offered by a plan should be allowed to enroll in or see the patients of 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.»

Status: There is no legislation currently introduced but there have been rumors that some groups have been meeting with legislators to push for introduction of such legislation.

If it does get introduced, WDA will be supportive of its passage; given the current economic climate, this will remain at a low priority unless passage appears to be more likely.

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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 dentist is on the premises and is available to the patient throughout the entire appointment.

2013 WDA Sourcebook

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 and could also provide additional exposure to practicing in both urban and rural underserved areas.

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

Status: Due largely to concerns about the ability to keep any “Tooth Sense” funds from being raided for filling the general budget deficit, the WDA has continually declined to pursue drafting and introduction of this proposal in recent years. WDA may reconsider its position on this issue should a constitutional amendment prohibit the executive and legislative branches from raiding segregated funds.

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).

WI Dental Practice Act/ Admin Rules/FAQs

WI Dental Practice Act/ Admin Rules/FAQs

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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: 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.

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WI 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.

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:

WI Dental Practice Act

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.

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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.

WI 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.

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.

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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.

WI Dental Practice Act

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

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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.

WI 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.

447.19 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.

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 2013 WDA Sourcebook

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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.

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.

WI Dental Practice Act

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.

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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.

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. The license renewal fees the state collects from the 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 of the DEB and the staff members needed for the DEB 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 hygienist • 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 Dr. John Grignon, Vice Chair 11711 W. Burleigh St. Milwaukee, WI 53222 414-778-5260 Term expiration: 2013 Dr. Mark Braden 101 Broad St., Ste. 203 Lake Geneva, WI 53147 Term expiration: 2014 Dr. Adriana Jaramillo 221 S. Water St. Stoughton, WI 53589 608-873-6464 Term expiration: 2013 Dr. Kirk Ritchie 5409 Everybody’s Road PO Box 396 Crandon, WI 54520 715-478-4313 Term expiration: 2013 Dr. Beth Welter 114 E. Blackhawk Ave. Prairie du Chien, WI 53821 608-326-7445 Term expiration: 2014

DENTAL HYGIENE MEMBERS Sandra Linhart, RDH, Secretary 2102 State Road 16 La Crosse, WI 54601 608-781-2822 Term expiration: 2014 Deb Beres, RDH 1856 Jeffery Lane Waukesha, WI 53186 414- 587-6544 Term expiration: 2016 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 Tom Ryan, Executive Director 1400 E. Washington Ave. Madison, WI 53702 608-261-2393

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 also call DEB staff director Berni Mattsson at 608-261-2393. Dentists also may find helpful information on the Department of Safety and Professional Services’ website: http://dsps.wi.gov.

WISCONSIN DEB

(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.

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 2013 WDA Sourcebook

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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.

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 board’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.

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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

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.

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 2.07 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.

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), 2013 WDA Sourcebook

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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.

History: Cr. Register, February, 1982, No. 314, eff. 3-1-82.

Administrative Rules

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.

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(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) Failing to supervise the practice of a dental hygienist as specified in s. 447.08 (1) or (4), Stats. and s. DE 3.01.

(20) Violating, or aiding or abetting the violation of any law substantially related to the practice of dentistry or dental hygiene.

(21) Aiding or abetting or permitting unlicensed persons in the practice of dentistry, as defined in s. 447.01 (8), Stats.

(22) Aiding or abetting or permitting unlicensed persons in the practice of dental hygiene, as defined in s. 447.01 (3), Stats.

Administrative Rules (23) 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.

(24) 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.

(25) 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.

(26) Practicing under an expired certificate of registration.

History: Cr. Register, October, 1999, No. 526, eff. 11-1-99.

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, October, 1999, No. 526, eff. 11-1-99; CR 11-035: am. (2) Register July 2012 No. 679, eff. 8-1-12.

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.

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.

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.

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.

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Administrative Rules

3. Chemistry, pharmacology and clinical properties of local anesthesia, vasoconstrictors, and topical anesthesia.

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.

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(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 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.

Administrative Rules 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 (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.

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.

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.

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. (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.

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Administrative Rules 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.

(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.

History: CR 04−095: cr. Register August 2006 No. 608, eff. 1−1−07.

Administrative Rules

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.

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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.

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.

Administrative Rules (b) Meets face-to-face at least once each year to discuss issues. (c) Has adopted by-laws governing the operation of the group.

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 13.05  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).

Administrative Rules

DE 13.03  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.

renewal of a license that expires on the first renewal date after the date on which the applicant is licensed.

(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 13.04  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 2013 WDA Sourcebook

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Wisconsin Dental X-ray Regulations

2013 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 2013 dental facilities were sent out in November 2012. If you do not have a 2013 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 2013 WDA Sourcebook

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Wisconsin Dental 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.

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.

X-ray Regulations

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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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.

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2013 WDA Sourcebook

WDA.org Be sure to visit us online for the latest news on everything dental!

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 DEA – Drug Enforcement Administration DEB – Dentistry Examining Board DHS – Department of Health Services EOB – Explanation of Benefits HIPAA – Health Insurance Portability and Accountability Act MA – Medicaid OSHA – Occupational Safety and Health Administration PHI – Protected Health Information WAC – Wisconsin Administrative Code WDA – Wisconsin Dental Association

Frequently asked practice and legal questions contents Frequently Asked Practice and Legal Questions

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Billing...................................................................................... 78 Children of divorced parents........................................................ 80 Delegation of duties................................................................... 81 Dental records........................................................................... 82 Domestic abuse......................................................................... 84 Medicaid and discounts.............................................................. 85 HIPAA...................................................................................... 88 Insurance and coordination of benefits.......................................... 90 Licensing and continuing education questions................................. 91 Employment law and human resources issues .............................. 92 Amalgam recycling and dental waste ........................................... 94 OSHA and CDC guidelines......................................................................94 Malpractice............................................................................... 94 Mandatory insurance/benefit coverage......................................... 94 Patient abandonment................................................................. 95 X-rays and Exams...................................................................... 95

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.).

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: • Statement that you are imposing a surcharge • Amount of the surcharge • Statement that the surcharge is not greater than your applicable cost of acceptance Disclosure on receipt – You must provide clear disclosure of the dollar amount of the surcharge on the transaction receipt you provide to your patient.

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.

I 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 an office policy for billing and collections.

It is highly recommended that you contact each credit card brand you accept to determine the maximum surcharge you are permitted to charge.

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.

WHAT REGISTRATION OR DISCLOSURE REQUIREMENTS MUST BE FOLLOWED IN ORDER TO IMPOSE A SURCHARGE?

You should also be aware that, 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

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.

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Your ability to apply a surcharge is conditioned on abiding by certain registration and disclosure requirements:

2013 WDA Sourcebook

Frequently Asked Practice and Legal Questions 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 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”.

1. Chapter 7: Liquidation 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. f) Usually, the court will appoint a committee of unsecured creditors (typically the larger creditors) to represent the creditors’ collective interests.

a) Similar to chapter 11 business reorganizations, chapter 13 allows an individual to submita 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 (the 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.

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.

Types of claims: Who gets paid first?

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

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).

Frequently Asked Practice and Legal Questions

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.

3. Chapter 13: Rehabilitation of individual debtors

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.

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).

Preference: When payment may NOT be a good thing 1. One philosophy behind the Bankruptcy Code is unsecured creditors should be treated 2013 WDA Sourcebook

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Frequently Asked Practice and Legal Questions equally. If one creditor receives a payment shortly before the debtor declares bankruptcy, other creditors may suffer disproportionately.

records can provide a written consent to permit disclosure of the child’s dental records to a step-parent.

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?

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.

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. 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. 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).

5. If you suspect bankruptcy is imminent:

Frequently Asked Practice and Legal Questions

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 “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.

Physical custody alone does not necessarily determine legal custody.

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).

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).

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? 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.

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.

2. CHILDREN OF DIVORCED PARENTS

The non-legally obligated parent cannot be required to pay even if they have records access – but there is seldom any harm in asking.

CAN A STEP-PARENT ACT ON BEHALF OF A MINOR CHILD TO PROVIDE INFORMED CONSENT AND AUTHORIZATION FOR DENTAL TREATMENT?

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.

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

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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).

2013 WDA Sourcebook

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 (group 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.

Frequently Asked Practice and Legal Questions 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).

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.

2. If both parents have the same birthday, the benefit of the group plan that has covered a parent the longest pays.

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.

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.

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

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.

3. DELEGATION OF DUTIES

A copy of a DEB-approved dental assistant training form can be obtained from the WDA Legislative Office at 888-538-8932.

CAN DENTISTS DELEGATE THE USE OF LASERS BY DENTAL HYGENISTS?

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.

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.

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

Scan the QR code to review the DEB position statement or visit http://1.usa.gov/16jPDr5.

Frequently Asked Practice and Legal Questions

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.

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 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:

WHAT ARE THE STATE STATUTES RELATING TO DELEGATION OF DUTIES TO A DENTAL ASSISTANT?

• 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.

Chapter 447-Wisconsin Statutes

• Deep scaling or root planning a human tooth.

Section 447.065

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

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.

• 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) 2013 WDA Sourcebook

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Frequently Asked Practice and Legal Questions 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.

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.

Frequently Asked Practice and Legal Questions

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? 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 facsimile 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?

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 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.

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.

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.

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.

WHO ‘OWNS’ A PATIENT’S DENTAL RECORDS?

That period is determined by the statute of limitations which is the time period when a claim must be brought.

As such, the patient has a right to examine and/or obtain a copy of their records at any time.

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).

The dentist owns the records, but the patient owns the information contained in the records 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 so 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. 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.

In dental malpractice actions, a patient must file a claim before the later of:

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.

• Three years from the date of injury.

WHO HAS A RIGHT TO ACCESS THE RECORDS OF A DECEASED PATIENT?

• 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.

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.

There are a number of exceptions to this statute of limitations.

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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.

2013 WDA Sourcebook

Following a patient’s death, the right to request and review records passes to the deceased’s personal representative.

Frequently Asked Practice and Legal Questions 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.

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

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 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.

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.

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.

Again, since the dentist is familiar with the records already, his or her possession of them should not present a confidentiality issue.

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.

Lastly, in this situation as well, we would recommend a form of agreement similar to that suggested above.

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.

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, 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.

• 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.

Frequently Asked Practice Legal Questions

WHAT HAPPENS TO PATIENT RECORDS IF I RETIRE OR LEAVE THE PRACTICE?

• To organ procurement organizations authorized to act with respect to the body

and

• To a public health authority collecting information for disease control purposes

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.

• To funeral directors to the extent necessary to the discharge of their duties

• 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.

2013 WDA Sourcebook

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Frequently Asked Practice and Legal Questions 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.

Actual fees are determined by the health care provider, but cannot exceed these maximum charges: • For paper copies: o $1.02 per page for the first 25 pages o $0.76 cents per page for pages 26 to 50 o $0.51 cents per page for pages 51 – 100 o $0.30 cents per page for pages 101 and above • For microfiche or microfilm copies: $1.52 per page • For print of X-ray: $10.15 per image • If the requester is not the patient or a person authorized by the patient: A single $8.12 charge for certification of copies and a single retrieval fee of $20.30 for all copies requested Actual shipping costs and any applicable taxes

Frequently Asked Practice and Legal Questions

Dentists are prohibited from charging full fees to MA patients:

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 discussed elsewhere).

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.

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.

The Wisconsin provision most likely to apply in police situations is Section 146.82(a) (4), which authorizes you to provide records pursuant to a court order.

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).

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.

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.

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.

The reduced fee requirement does not apply if the health care provider is the DHS or the Department of Corrections.

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.

5. DOMESTIC ABUSE AM I PERMITTED TO REPORT SUSPECTED CHILD ABUSE IF I OBSERVE SYMPTOMS DURING MY TREATMENT OF A PATIENT?

Sales taxes, if applicable, may also be added to the fee limits. When records are needed by or on behalf of indigents, the state Department of Health Services encourages health care providers to provide those records at as low a cost as possible.

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”.

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.

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.”

The adjustment to the allowed charges for copying records will be published in the Wisconsin Administrative Register.

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.

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.

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

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of records to the designated person or dental office. All releases of any patient information needs to be documented in the patient record.

2013 WDA Sourcebook

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.

Frequently Asked Practice and Legal Questions 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.

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.

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.

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 for fear of becoming overwhelmed with MA patients.

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.

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.

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.

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.”

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

• Taking only a set number of new MA patients in each month or year on a first-come, first-served basis.

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 excessive paperwork, 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.

Frequently Asked Practice and Legal Questions

Wisconsin treats adult abuse very differently – presumably because the patient is an adult and can take steps for their own protection.

These might include:

• 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.

• 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.

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Frequently Asked Practice and Legal Questions 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.

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.

Frequently Asked Practice and Legal Questions

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, the office should file an emergency MA claim with DHS and get paid MA rates for services provided without going through the entire certification process. All forms are available by calling 800-947-9627 or visit www.dhs.wisconsin.gov/forms/F-1.asp.

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 800362-3002. 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.

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

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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 NOT COVERED BY MA, CAN THE DENTIST BILL THE PATIENT FOR A 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.”

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

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.

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 co-payment provisions of a contract by agreeing to forgive any or the patient’s entire obligation for payment under the contract.

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.

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).

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.

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

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.

However, this does NOT apply for dentists who are MA-certified providers, but not accepting new MA patients.

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 Code.

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

The WAC version is written as an absolute without repetition of the statute’s “repeated irregularities” reference.

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Frequently Asked Practice and Legal Questions IF I CANNOT FORGIVE CO-PAYMENTS, CAN I EVER OFFER DISCOUNTS? Arguably, yes. While offering discounts is not explicitly prohibited, discounting can raise a number of unintended and/or unexpected issues.

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.

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

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.

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.

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.

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.

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.

• 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.

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.

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.

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

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.

Frequently Asked Practice and Legal Questions

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.

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.

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.

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 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.

There is no requirement chamber dollars must be applied to the patient’s dental account or used in exchange for dental services.

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Frequently Asked Practice and Legal Questions 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.

The WDA does not believe the use of chamber dollars creates an issue in this regard.

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.

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

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.

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

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.

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.

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.

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.

As long as the chamber dollars are not used in this way; it is not seen as violating any state statutes.

Frequently Asked Practice and Legal Questions

WHAT DOES THE ELECTRONIC TRANSACTIONS AND CODE SETS RULE REQUIRE?

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 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 electronic transactions and code sets 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.

The ADA CDT 2013 is the only set of dental codes that insurers will accept electronically via the nationwide HIPAA format.

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.

WHAT BASIC STEPS CAN DENTAL OFFICES TAKE TOWARD COMPLIANCE WITH ELECTRONIC 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 HIPAA complaint format should be available through current software packages.

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 800621-8099 to order the CDT 2013 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 March 26, 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. Dental practicres will have an additional 180 days, or until September 23, 2013 to comply with the new requirements. The regulations are: • Enhance HIPAA enforcement; • Expand HIPAA requirements to business associates (BAs) who receive protected health information; • Expand 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; • Require modifications, and redistribution of, Notice of Privacy Practices;

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

• Modify rules applying to marketing and fundraising communications and the sale of protected health information, allowing patients to “opt out”;

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

• Expand definition of “health information” to include genetic information;

WHAT IS THE BEST WAY TO STAY CURRENT WITH HIPAA AS IT CHANGES?

• Clarify when data breaches MUST be reported to HHS Office for Civil Rights.

Members can stay informed via the ADA and WDA monthly publications and websites.

Additional HIPAA information can be found on:

Modified HIPAA Privacy forms and additional information can be obtained by contacting The Dental Record at 800-243-4675 or www.dentalrecord.com; or if there are additional questions, contact Erika Valadez at the WDA Legislative office at 888-538-5932 or evaladez@ wda.org.

• www.ada.org/goto/hipaa

The following are basic steps dental offices can take toward compliance with the privacy rule:

• www.wda.org

1. Name someone on your staff to serve as privacy officer.

• www.hipaacow.org (HIPAA Collaborative of Wisconsin website)

2. Keep current on HIPAA through the ADA and WDA communications and other online sources listed previously.

Both tools offer concise, dental-specific guidance and up-to-date information.

• www.hipaa.com • www.hhs.gov/ocr/privacy

3. Have your privacy officer conduct “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).

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.

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Frequently Asked Practice and Legal Questions ARE THERE AREAS OF PATIENT PRIVACY WHERE STATE LAWS ARE STRICTER THAN THE FEDERAL HIPAA PRIVACY RULE?

such as encrypted emails or electronic exchanges of PHI that require a password or key to read, while all other PHI is considered unsecured.

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:

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.

• 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, 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.

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.

For more information, contact the WDA Legislative Office at 888-538-8932.

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.

WHAT IS THE SECURITY RULE AND WHAT STEPS CAN DENTAL OFFICES TAKE TOWARD COMPLIANCE?

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 new rule.

The purpose of the HIPAA Security Rule is to protect the confidentiality, integrity and availability of electronically submitted protected health information whereas the HIPAA PrivacyRule applies to all patient information whether oral, written or electronic.

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.

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 March 2013.

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.

• Providers required to document each time a patient or a patient’s personal representative comes to inspect medical/dental records.

Dental offices can take the following basic steps toward compliance with the security rule: • Appoint a security officer; this person may also be the privacy officer, contact person and/or the dentist.

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

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

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

WHAT NEEDS TO BE DONE WITH REGARDS TO THE HIPAA/HITECH BREACH NOTIFICATION RULE? In 2009, the American Recovery and Reinvestment Act put forth new 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.

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.

Some basic questions to ask if one discovers a possible breach include: • Is notification of the breach required?

AN UNHAPPY PATIENT HAS MADE THREATS TO BOTH THE DENTIST AND STAFF. THE STAFF FEELS 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? 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.

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

Disclosures should be limited to: • 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).

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

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

• 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.

• Who needs to provide the notification?

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

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

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

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

• Who receives this notification?

• Reporting child abuse or neglect.

• How should I provide the notification?

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

If a breach is suspected, an office must first determine if the PHI was secured or unsecured.

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

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

Secured PHI does not required notification while unsecured PHI does.

Secured PHI is considered unusable, unreadable or indecipherable to any unauthorized persons

Frequently Asked Practice and Legal Questions

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.

• Alerting law enforcement to the death of an individual when suspected the death was a result from criminal conduct.

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Frequently Asked Practice and Legal Questions • 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.

8. INSURANCE AND COORDINATION OF BENEFITS

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

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.

The Wisconsin Office of the Commissioner of Insurance regulates dental benefit plans. If a patient were to lodge a UCR complaint, OCI would investigate the case and report back to the patient within an allotted time frame.

• 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.

Only after exhausting the plan’s internal grievance process will OCI take action. In addition to complaint-driven UCR 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?

Frequently Asked Practice and Legal Questions

HOW DO YOU DETERMINE PRIMARY AND SECONDARY COVERAGE?

WHO REGULATES DENTAL INSURERS TO MAKE CERTAIN THE DATABASES THEY MAINTAIN ARE COMPLIANT WITH WISCONSIN LAWS?

However, prior to contacting OCI, patients should first correspond directly with the dental benefit plan.

OCI complaint processing guidelines can be found on http://oci.wi.gov/com_form.htm and complaint form can be printed on http://oci.wi.gov/ociforms/51-005.pdf.

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

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

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.

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.

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.

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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.

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• 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.

• 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.

COB should happen between carriers.

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:

Frequently Asked Practice and Legal Questions • 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.

• 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.

IS THERE 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? A sample letter follows.

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.

On the attached explanation of benefits, dated ________, your organization denied me full payment of the actual charge submitted by my dentist, Dr. ____________.

Please provide me with the information listed below related to my claim: • Dental Code #___________________ • Method of determining the maximum allowable benefit • The number of charges collected for that procedure • The Zip code(s) where the charges were collected • Time frame in which charges were collected • Highest and lowest charge • Percentile of the allowable charge • The date of the last update

(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).

9. LICENSING AND CONTINUING EDUCATION QUESTIONS WHAT LICENSES DO I NEED TO PRACTICE IN WISCONSIN? 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.” 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. Controlled substances may only be prescribed or dispensed in the course of a dental practice.

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.

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

DO I NEED A SEPARATE LICENSE TO PRACTICE A SPECIALTY? While some states issue specialty licenses, no such license is required or available in Wisconsin.

• The percentile upon which payments are made

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

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.

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

Sincerely,

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.

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 and 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.

and

Dear _________________________:

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 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.

Frequently Asked Practice Legal Questions

Address letter to insurance company, claims administrator or third party payer listed on the explanation of benefits.

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.

DO I NEED TO HAVE A SPECIAL PERMIT TO PROVIDE SEDATION TO PATIENTS IN MY DENTAL PRACITCE? 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.

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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, 2013 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.

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.

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.

MUST EMPLOYERS PAY FOR THEIR EMPLOYEES’ 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? a. 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). b. 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.

• 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.

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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 we will not pay for CE registration • We will not pay travel or other CE-related (room, meals, etc.) expenses • You may only attend CE: a. If course is approved 45 days in advance to permit appropriate scheduling of patient appointments b. If we are able to schedule appropriate alternatives for patient appointments on that date c. On days you are not scheduled to work d. 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 ISSUES 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 five inches by seven 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 CONVENANTS 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, Ozaukee and Waukesha counties would most likely depend on where the practice’s patients are located.

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, pay increase, contract extension or something else. Wisconsin courts have held that simply not getting fired is not adequate consideration since you had the job already.

Frequently Asked Practice and Legal Questions 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.

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).

• 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.

IF I AM JOINING AN EXISTING PRACTICE, SHOULD I INSIST ON A WRITTEN EMPLOYMENT CONTRACT?

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.

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.

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.

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.

For example, if, as employer, you paid $800 per month of the premium 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.

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.

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.

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.

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.

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.

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:

and

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).

Thus, while not required, it is recommended you have at least some form of written employment agreement detailing what has been agreed upon.

Frequently Asked Practice Legal Questions

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.

Still, if it is hard to do a contract at the start, think how difficult it could be later if issues arise.

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.

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 2013 WDA Sourcebook

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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.

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 98 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 GUIDELINES 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 (login required).

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.

Visit for more information. 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.

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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 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).

Frequently Asked Practice and Legal Questions

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

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 due to the patient’s: • Failure to cooperate with prescribed treatment • Failure to pay for services • Failure to 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: 1. 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.

2. If the dentist terminates the relationship: • Complete outstanding treatment plan if possible.

• Transfer care at a logical breaking point in the treatment (patient health should not be compromised).

• Allow sufficient notice for patient to locate another dentist (30 days).

• Provide emergency care for a reasonable period of time (30 days).

• Document telephone conversations and correspondence.

• Provide written notice by certified mail (if terminating the relationship for reasons other than the closing of your practice at that location), including: o The date the relationship will end. Give a reasonable period of time. o Provide guidance on how to find a new dentist. o Offer instructions as to how to request a transfer of the patient’s records to the new dentist. o Include the time period during which you will give emergency care while a new dentist is sought as the status of the patient’s dental health and an outline of treatment that will be needed in the future. o Include a copy of the letter in the patient’s permanent record.

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)?

Frequently Asked Practice and Legal Questions

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.

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.

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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

The Dental Record (patient 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, secure prescription paper, 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.

Patient eForms (online patient forms) Patient eForms is an online, secure, patient registration system that allows your patients to complete their forms online prior to their appointment. You can add a direct link to your office website. The forms can be retrieved by your staff as PDF files. The solution is as little as $4.99 per month. Log on to www.patienteforms.com for more information or to get started or call 800-243-4675.

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.

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 offices. 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.

AMO - Association Members Only (office supplies) Check out the fantastic meet-or-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.

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CareerConnection (online job center) WDA CareerConnection is the only 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.

Delta Gloves (examination gloves) All type of gloves including latex, powdered and powder free, vinyl and nitrate are available. Delta has more than 20 years of glove distribution expertise and will help you choose the best and most affordable gloves for each member of your dental team. For more information call 800-633-6867 for samples or visit www.DeltaGloves.com.

FedEx Advantage Program (shipping) Practices save up to 27 percent on selected shipping services. No enrollment fees or minimum quotas. Call 800-members or apply online.

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 online search engine 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 turnkeymarketing 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) 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. Call 800-525-7117 or visit www.OmniaGroup.com for more information on testing.

Recommended Products, Programs and Services

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 888-5753273 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 www. scientificmetals.com to see some of the great associations who have entrusted us with their members’ scrap.

FINANCIAL SERVICES

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 a additional payment option. Over the past 25 years, more than 20 million patients have chosen to use CareCredit and today, 90,000 enrolled dental patients accept CareCredit. In celebration of 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.

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.

Mercer Advisors (financial planning) – Mercer Advisors is one of the nation’s largest planning and investment management firms serving 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.

Brought to WDA Members by:

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 today.

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.

Recommended Products, Programs and Services

Sharps Compliance (medical waste disposal) – Sharps Compliance is a leading provider of innovative, cost-cutting, environmentally-responsible solutions for medical waste, used health care materials, and amalgam generated in the dental industry. Sharps® Recovery System™ can reduce costs by 50 percent or more. No long-term contacts required.

Compliant with applicable regulations. No landfills required. For more information call 800-772-5657 or visit www.sharpsinc.com.

Transworld Systems Inc. (credit and collections) – Transworld Systems Inc. is the nation’s leader for helping over 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 how to optimize and systemize your A/R process, please call 608-276-8307 or visit www.web.transworldsystems.com/madison.

OTHER PRODUCTS

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.

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 (Auto) – Save $2,000 to $4,000 on the purchase or lease of a new Mercedes-Benz. This leader in luxury vehicles offers over 55 models to satisfy every driving style. Visit ada.org/Mercedes or call 866-628-7232 to learn more.

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).

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WDA Insurance Programs

YOUR FULL-SERVICE INSURANCE AGENCY 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.

Wisconsin Dental Association 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.

WDA Insurance Programs

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 WDAIP. 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 Health Insurance Program The WPS Preferred Advantage Plus program is a superior preferred provider plan offering WDA members and their employees’ comprehensive coverage, freedom of choice, proven cost-saving strategies and flexible plan options including HSAs. 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 Group Life and Disability n Office Overhead Expense Coverage n Individual Health 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

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 WDAIP to be your trusted partner, invaluable resource and a true member benefit.

Contact us today at 800-242-9077, 414-277-7727, info@insuranceformembers.net or visit our website at www.insuranceformembers.com.

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Member Directory

#1 Lost or Stolen Local Drive

Pick Your Disaster Backing up your data locally to tapes or an external hard drive? Under new federal HIPAA/ HITECH laws, Disaster #1 would require you to notify every patient and the local print/ broadcast media, or face sizable fines.

Disasters #2-4 would require you to restore your backed up data in a timely fashion.

Do you know how to do this?

Member Directory

#2 Hardware Crash

Contact The Dental Record for a FREE Data Assessment from Central Data Storage.

Learn how Online Data Backup can automatically backup and protect your data, restore your data at any time for you, and cost less than you spend now.

Managed Online Data Backup 800-243-4675

#3 Fire

www.dentalrecord.com/centraldatastorage

The

#4 Natural Disaster

Dental Record Professional Services

Pyramid of Pride Recognition Program

Pyramid of Pride Recognition Program The Wisconsin Dental Association is proud to honor the 2012 Pyramid of Pride recipients who received their awards during a special dinner on Nov. 16, 2012 at the Hyatt Regency in Milwaukee.

Lifetime Achievement Award Dr. Kathleen Roth (West Bend)

West Bend resident and general dentist Dr. Kathleen Roth received the 2012 Wisconsin Dental As sociation Lifetime Achievement Award in recognition of her significant contributions of time, energy and expertise to organized dentistry throughout her 38-year career.

An outstanding leader, Dr. Roth served as president of her local dental society and the WDA. In 2006, Dr. Roth was the third Wisconsin dentist to be elected president of the American Dental Association.

In addition, Dr. Roth has served on governing boards for the WDA Foundation, National Foundation of Dentistry for the Handicapped, National Museum of Dentistry, America Dental Education Association and America’s Dentists Care Foundation. She also worked tirelessly on the WDA Mission of Mercy state committee.

A 1974 Marquette University School of Dentistry graduate, she has been on the Dean’s Advisory Council since 1995.

She currently chairs the school’s “Building for the Future” Fundraising Committee.

Fellow dentists have welcomed Roth into three honorary professional organizations, including the Pierre Fauchard Academy, American College of Dentists and International College of Dentists.

Thomas Witkowski, former WDA Insurance and Services Corp. president

Media Awareness Award

Pyramid of Pride Recognition Program

WDA Foundation Philanthropic Award

Political Action Award Dr. Christopher Hansen (Green Bay) and

WISC-TV 3 (CBS) in Madison

Media Relations Award Friends of Dentistry

Dr. Jeff Jones (Eau Claire)

Dr. Brian Hodgson (Lake Geneva)

America’s Dentists Care Foundation Mr. Bruce Bergstrom

First Supply of La Crosse Mr. Joe Poehling

Drs. Joel Supita (Crivitz) and Jamie Mandigo (Crivitz)

WDA Award of Honor Dane County Dental Society

New Dentist Leadership Award Dr. Allison Dowd (Fitchburg)

Nominations are accepted year-round, but submit them no later than July 15, 2013 to be considered for a 2013 award.

See reverse side for award nomination form and visit WDA.org for complete descriptions.

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Past-Presidents

Past-president listing is also available online at WDA.org First Last Name Initial City Term D.W. E. A. C.C. C.W. R.S. S.M. S.M. J.M. Wm. M.T. G.H. L.C. J.S. B.G. J.S. W.H. W.F. W.H. E.F. C.P. E.C. W.C. W.C. C.C. C.A. T.B. R.G. C.W. J.H. E.A. E.A. T.M. A.G. H.T. F.G. W.H. W.H. W.H. H.N. J.L. H.L. R.J. T.A. Wm. O.G. L.A. E.A. E.A.

Milwaukee La Crosse Milwaukee Madison Fond du Lac Sparta Beaver Dam Beaver Dam Elkhorn Oshkosh La Crosse Janesville Waupun Monroe Milwaukee Milwaukee Appleton Milwaukee Milwaukee Black River Falls Milwaukee Eau Claire Milwaukee Milwaukee Milwaukee Milwaukee Portage Milwaukee Monroe Lancaster La Crosse La Crosse Waupun Superior Fond du Lac Hurley Milwaukee Milwaukee Madison Milwaukee Superior Milwaukee Milwaukee Fond du Lac Milwaukee Milwaukee Oconomowoc Milwaukee Milwaukee

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First Last Name Initial City Term 1919-20 Hall 1920-21 Hall 1921-22 Oviatt 1922-23 Gropper 1923-24 Wright 1924-25 Donovan 1925-26 Mortonson 1926-27 Stratton 1927-28 Crawford 1928-29 Crawford 1929-30 Wheeler 1930-31 Cleophas 1931-32 Mortell 1932-33 Huegel 1933-34 Huegel 1934-35 Morgan 1935-36 Nelson 1936-37 Hansen 1937-38 Wetzel 1938-39 Moen 1939-40 Wilson 1940-41 Redeman 1941-42 Baumann 1942-43 Martin 1943-44 Justin 1944-45 Baumgartner 1945-46 Cavanaugh 1946-47 LeSage 1947-48 Schaller 1948-49 Finke 1949-50 Uebele 1950-51 Bennett 1951-52 Dresen 1952-53 Calkins 1953-54 Hahn 1954-55 Smith 1955-56 Semrau 1956-57 Kelly 1957-58 Mason 1958-59 Huxtable 1959-60 Kopp 1960-61 Spaeth 1961-62 Hoppe 1962-63 Skaalen 1963-64 Kieren 1964-65 Ryan 1965-66 Del Balso 1966-67 Scribner 1967-68 Kraus

Deceased

C.W. Milwaukee C.W. Milwaukee E.C. Columbus A. Milwaukee J.J. Milwaukee J.M. Neenah M.H. Milwaukee G.A. Oshkosh J.W. Milwaukee J.W. Milwaukee D.P. Madison G.E. Beloit J.F. Oshkosh R.W. Madison R.W. Madison G.E. Milwaukee C.A. Amery M.C. Racine E.C. Milwaukee O.H. Watertown G.W. Milwaukee E.H. Marinette C.J.,Sr. Milwaukee F.J. Medford J.P. Milwaukee J.F. West Bend M.G. Milwaukee G.A. Superior W.H. Milwaukee A.H. Sheboygan H.M. Milwaukee G. Wisconsin Rapids O.M. Milwaukee E.D. Racine H.F. Milwaukee M.W. Janesville J.S. Milwaukee J.D. La Crosse R.A. Milwaukee H.S. Mineral Point A.E. Menomonee Falls V.K. Chippewa Falls H.O. Milwaukee L.O. Stoughton H.L. Milwaukee T.E. Waukesha M.J. Wauwatosa L.C. Stevens Point E.E. Milwaukee

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First Last Name Initial City Term

Deceased

1968-69 Grewe H.G. Eau Claire 1969-70 Baumann C., Jr. Milwaukee 1970-71 Shuler F.F. Clinton 1971-72 Gertler C. Glendale 1972-73 Podruch L.L. Wausau 1973-74 Leone E.F. West Allis 1974-75 Sterr A.M. De Pere 1975-76 Copoulos P.C. Milwaukee 1976-77 Sabin N.M. Elkhorn 1977-78 Cohn P.P. Shorewood 1978-79 Simley D.O. Madison 1979-80 Green H.D. Beloit 1980-81 Ziegler C.L. Wauwatosa 1981-82 Hambuch C.A.,Sr. Ashland 1982-83 Larson G.A. Brookfield 1983-84 Englander J.A. Milwaukee 1984-85 Sime C.I. Madison 1985-86 Sampe D.A. Mequon J.P. Milwaukee 1986-87 Treacy 1987-88 Strand R.J. La Crosse 1988-89 Groth G.K. Appleton 1989-90 Van Miller J.L. Green Bay 1990-91 Inda M. Waukesha 1991-92 Rose S.T. Appleton 1992-93 Stifter R. Milwaukee 1993-94 Oberbreckling P. Mequon 1994-95 Lindstrom S.R. Howards Grove 1995-96 Sadowski J.L. Manitowoc 1996-97 Maihofer G.T. Milwaukee 1997-98 Swanson L.C. Oshkosh 1998-99 Roth K. West Bend 1999-00 McNamara T.J. Greenfield Cassville 2000-01 Hughes T. 2001-02 Springborn J. Appleton 2002-03 Donohoo M. Milwaukee 2003-04 Engel D. Mequon 2004-05 Jaeger F. Madison 2005-06 Stamatelakys C. West Allis E. Onalaska 2006-07 Dahl 2007-08 Hebl M. Milwaukee 2008-09 Kaske H.M. Twin Lakes Chippewa Falls 2009-10 Vandehaar K. 2010-11 Shoemaker E. Waukesha S. Neenah 2011-12 Stoll

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* * *

Past-presidents

1870-71 Perkins 1871-72 Palmer 1872-73 Holbrook 1873-74 Chittenden 1874-75 Barnes 1875-76 Wells 1876-77 Gilman 1877-78 Gilman 1878-79 Barker 1879-80 Decker 1880-81 Moore 1881-82 McCausey 1882-83 Stewart 1883-84 Reynolds 1884-85 Maercklein 1885-86 Perkins 1886-87 Chilson 1887-88 Lewis 1888-89 Carson 1889-90 Long 1890-91 Southwell 1891-92 French 1892-93 Wendel 1893-94 Wendel 1894-95 Chittenden 1895-96 Southwell 1896-97 Fletcher 1897-98 Richter 1898-99 Bennett 1899-00 Reed 1900-01 Gatterdam 1901-02 Gatterdam 1902-03 Welch 1903-04 Fee 1904-05 Sackett 1905-06 Van Stratum 1906-07 Cudworth 1907-08 Cudworth 1908-09 Mueller 1909-10 Jackson 1910-11 Malone 1911-12 Banzhaf 1912-13 Wenker 1913-14 Hardgrove 1914-15 Hopkinson 1915-16 Krause 1916-17 Meyer 1917-18 Geilfuss 1918-19 Geilfuss

Deceased

149

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West Allis, WI 53214

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Email: cpeacy@wda.org.

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150

2013 WDA Sourcebook

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