Tenn. Comp. R. & Regs. 0460-02-.11 - REGULATED AREAS OF PRACTICE

(1) Policy Statement - The scope of the practice of dentistry in Tennessee is broadly defined and includes many aspects which if not particularly regulated could lead to serious ramifications for the consuming public. This rule is to designate specific areas in the practice of dentistry for regulation, the violation of which may result in disciplinary action pursuant to T.C.A. §§ 63-5-124(a)(1), 63-5-124(3), 63-5-124(4), 63-5-124(7), 63-5-124(8), 63-5-124(16) or 63-5-124(18).

(2) Prescribing, Dispensing, or Otherwise Distributing Pharmaceuticals

(a) Dentists who elect to dispense pharmaceuticals for compensation or otherwise distribute pharmaceuticals must comply with the following:

1. All Federal Regulations ( 21 CFR 1304 through 1308 ) for the dispensing of controlled substances.

2. Requirements for dispensing of non-controlled drugs are as follows:

(i) Drugs are to be dispensed in an appropriate container labeled with at least, the following:

(I) Patient's name

(II) Date

(III) Complete directions for usage

(IV) The dentist's name and address

(V) A unique number, or the name and strength of the medication

(b) Dentists may prescribe, dispense or otherwise distribute the controlled substances listed in Schedules II, III, IV, and V, as provided in 21 C.F.R. Chapter 2, 1308.12 through .15, only to individuals with whom they have established a dentist/patient relationship and for whom they have provided dental services. For purposes of this provision, a "dentist/patient" relationship exists where a dentist has provided dental treatment to a patient on at least one (1) occasion within the preceding year, or exists by having adequate documented knowledge of the specific patient history.

(c) Dentists must confine their prescription, dispensing or distributing of pharmaceuticals to those which are directly associated with and recognized for the treatment of an identified dental procedure, ailment or infirmity.

(d) Dentists must not prescribe, dispense or otherwise distribute controlled substances in amounts, or for durations not medically or dentally necessary, advisable or justified by an existing, identifiable dental procedure, ailment or infirmity.

(e) Dentists must record in patient records all pharmaceuticals dispensed, prescribed or otherwise distributed to patients. A separate log must be maintained for all controlled substances dispensed by a dentist.

(f) It is not the intention of this rule to interfere with the individual dentist's appropriate use of professional samples, nor to interfere in any way with the dentists right to directly administer drugs or medicines to any patient.

(g) Dentists shall only allow licensed or registered auxiliary staff to give/hand medications to a patient and only after the dentist has verified that the medication about to be given is the correct medication and correct dosage prescribed. Under no circumstances shall the dentist allow auxiliary staff to place medications directly in the mouth of a patient or on the patient such as actisite, nitrous oxide, any other medicated dental material, etc., with the exception of a topical anesthetic pursuant to T.C.A. §§ 63-5-108(b) (12) and/or (d) (3), and any other procedure authorized by Rule 0460-03-.09(1).

(h) Nothing in these rules shall be interpreted to interfere with the ability of properly credentialed dentists who practice in the hospital setting to reinstate, continue, and/or rewrite for their patients all prescriptions which are medically or dentally advisable or justified for such dental procedure(s) or treatment(s), including prescriptions for ancillary medical conditions, so long as:

1. such medical prescriptions are rational to the practice of dentistry; and

2. the treating dentist only orders such medical prescriptions in consultation with the patient's treating physician; and

3. the treating dentist only re-orders such medical prescriptions which already have been ordered by the patient's treating physician and which prescription orders would remain in effect for the patient but for the JCAHO standard against automatic reinstatement in the hospital setting.

(3) Third Party Payor Practices. The following acts or omissions by or on behalf of any dentist may be grounds for disciplinary action:

(a) Abrogating the deductible or repeatedly or regularly waving co-payment or both provisions of any insurance contract or dental plan by forgiving any or all of a patient's obligations for payment of said deductible or co-payment or both without first notifying the insurance company or dental plan in writing of the intent to do so.

(b) Rebating or repeatedly or regularly waiving or offering to rebate to an insured any payment by the insured's third-party payor to the licensee for services or treatments rendered under the insured's policy, without first notifying the insurance company or dental plan in writing of the intent to do so.

(c) Submitting to a third-party payor a claim for a service or treatment at an inflated fee or charge or one greater than the licensee usually charges for the service or treatment when such is rendered without third-party reimbursement.

(d) Knowingly incorrectly reporting services rendered, reporting incorrect treatment dates, or reporting charges for services not rendered, or filing claims prior to completion of services for the purpose of obtaining payment from a third-party payor unless the payor is notified in writing at the time of filing for payment.

(4) Laboratory Work Orders

(a) A written work order must accompany all dental laboratory work sent by a dentist to a commercial dental laboratory or private dental laboratory technician outside the physical confines of the ordering dentist's office.

(b) A copy of all written work orders required by this rule must be kept on file by the ordering dentist for a period of two (2) years from the date the order was issued.

(c) All written work orders required by this rule must include the following information:

1. Date signed.

2. The name and address of the commercial dental laboratory or private dental laboratory technician.

3. The name or identification number of the patient for whom the act or service is ordered.

4. The licensed dentist's name, address, and license number.

5. The signature of the licensed dentist.

6. The description of the kind and type of appliance, process, fabrication, service, or material ordered.

(5) Unauthorized Practice - Any dentist who permits any dental hygienist or dental assistant to perform any acts or services other than those specifically assignable or delegable pursuant to T.C.A. § 63-5-108 and/or Rule 0460-03-.09 and/or 0460-04-.01 and 0460-04-.08 may be subject to discipline pursuant to T.C.A. § 63-5-116(a).

(6) Universal Precautions for the Prevention of HIV Transmission - The Board adopts Rules 1200-14-03-.01 through 1200-14-03-.03 inclusive, of the Department of Health, and as they may from time to time be amended, as its rules governing the process for implementing universal precautions for the prevention of HIV transmission for health care workers under its jurisdiction.

Notes

Tenn. Comp. R. & Regs. 0460-02-.11

Original rule certified June 7, 1974. Repeal filed August 26, 1980; effective December 1, 1980. New rule filed December 11, 1991; effective January 25, 1992. Amendment filed June 20, 1994; effective September 3, 1994. Amendment filed June 29, 1994; effective September 12, 1994. Amendment filed May 15, 1996; effective September 27, 1996. Amendment filed February 9, 2000; effective April 24, 2000. Amendment filed October 20, 2003; effective January 3, 2004. Amendment filed May 28, 2004; effective August 11, 2004. Amendment filed September 25, 2008; effective December 9, 2008.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-5-105, 63-5-107, 63-5-108, 63-5-109, 63-5-116, 63-5-122, and 63-5-124.