Regulatory Information

EPA Dental Rule Compliance- Amalgam Waste and Mercury Discharge
On June 14, 2017, the United States Environmental Protection Agency announced pretreatment standards to reduce discharge of mercury from dental offices into a publicly owned sanitary sewer system. This new federal rule is separate from the state rule, and took effect on July 14, 2017. It applies to most dental offices, with some exceptions. The rule requires offices to submit a one-time certification form and comply with updated Best Management Practices. For more information, please review this DEQ factsheet, which includes more information on exceptions to the rule and municipality contact information.

Oregon law require dentists to follow ODA Best Management Practices and install an amalgam separator.
Senate Bill 704 took effect January 1, 2008, and subsequently was revised in 2009 with House Bill 3611, requiring Oregon dentists who place or remove mercury-containing materials from the oral cavity to install a separator. The law also requires all Oregon dentists to be in compliance with ODA's Best Management Practices (BMPs).

How does this requirement affect you?
If your practice doesn't place or remove dental amalgam or other dental materials containing mercury, you most likely will not have to install an amalgam separator. One exception may be if during tooth extraction a dentist cuts through amalgam, in which case you will still need to install a separator.

January 1, 2010 was the date when all dental offices were required to install amalgam separators in their offices. If you are building a new office or operatory, amalgam separators are required in all new dental office construction after January 1, 2008.

ODA Resources
ODA Guide to Best Management Practices of Dental Wastes
ODA Guide to Recyclers

ADA Resources
ADA Statement on Dental Amalgam
ADA Guide to Amalgam
ADA Guide to Amalgam Separators and Waste Best Management

Additional Resources
EPA Dental Effluent Guidelines
EPA Frequently Asked Questions
Clean Water Services Dental Office Pollution Prevention Guide
DEQ Dental Fact Sheet and Contact Information

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was signed by President Clinton August 21, 1996 as Public Law 104-191. Included in the law is a separate section intended to reduce the administrative costs of health care. Final regulations on transactions and code sets were released on August 17, 2000 for implementation by October 16, 2002.

The law requires all health plans, including ERISA, health care clearinghouses and any dentist who transmits health information in an electronic transaction to use a standard format. Those plans and providers that choose not to use the electronic standards can use a clearinghouse to comply with the requirement. Providers' paper transactions are not subject to this requirement.

What is HIPAA?

HIPAA has four main elements:

1. Portability of coverage
2. Security of health information
3. Consents for uses of health information
4. Electronic transmission of health information

Key things to remember

HIPAA regulations require you to make a "good faith effort" to secure patient receipt of your privacy practices notice before you disclose protected health information (PHI).

• Adhere to the "minimum necessary standard." You are required to use or disclose only the information needed to accomplish the purpose intended.
• The key word to remember is "reasonable" when reviewing changes in your office to comply with HIPAA standards.

What do we need to do to comply?

Whether or not you transmit electronic claims, patient confidentiality is key in any dental practice. Check with your liability carrier regarding confidentiality laws. Confidentiality laws have been in existence long before Federal HIPAA regulations. HIPAA regulations dictate that healthcare providers and payers must safeguard the privacy of patient health information. Effective April 14, 2003 mandatory compliance with the privacy part of the HIPAA rule is required, especially in the areas of how patient health information is handled and secured.

If your office must implement HIPAA Privacy rules, follow steps to implement and train staff. Even if you do not have to implement privacy policy and rules, you may have to implement HIPAA Security. Check with the American Dental Association or the HHS Office of Civil Rights for information on whether these rules apply to your office.

No liability policy will protect you for violating federal law. Compliance with the Federal Privacy rule became effective April 14, 2003. If you are a new office implementing HIPAA privacy rules, the following are helpful:

1. Become knowledgeable about the requirements of the rule. The American Dental Association has a HIPAA Privacy Manual and a HIPAA Security Manual, both available through ADA 1-800-947-4746 or online at www.adacatalog.org.
2. Assign a Privacy Officer. This individual should be responsible for the Privacy program and for addressing questions, concerns, and complaints related to privacy.
3. Document policies and procedures, and set a timeline for their completion.
4. Review and revise current office policies around patient privacy according to HIPAA Privacy Rule requirements.
5. Document implicit or verbal rules around maintaining patient confidentiality.
6. Understand and generate policies or procedures for new requirements.
7. Create and reference required forms under the Privacy Rule within documented policies and procedures. For instance, documentation around an authorization form's purpose and usage is crucial.
8. Train your staff on your privacy practices. Ongoing training under the rule is also mandatory. Maintain documentation to demonstrate compliance. For assistance, contact the ODA Director of Government Affairs at 503-218-2010 Ext. 102.
9. Establish an audit program to monitor adherence to office privacy policies and procedures. This enables your office to pinpoint areas for improvement and areas of excellence in compliance.

Additional Resources

• ODA Endorsed Program ASPIDA email encryption
• ODA Endorsed Program DBIC CyberSecurity Insurance
• American Dental Association
• Office of Civil Rights (OCR)
• Oregon Dental Executives Association

The following may be able to help ODA members properly dispose of infectious and medical waste:

• Oregon Department of Environmental Quality
• Search in your local business directory under "Infection and Hazardous Waste Disposal" or "Medical Waste Disposal"
• Many local garbage haulers pick up sharps and other waste on a different day of the week from regular trash pick up.  Do not co-mingle infectious waste with regular trash, and check with your local hauler for details.

Sharps Disposal
Oregon law requires that regulated medical waste be stored and disposed of in rigid, leak proof, puncture-resistant containers clearly marked with the bio-hazard symbol, and sealed for safety.

Sharps are medical instruments such as needles, IV tubing with needles, scalpel blades, lancets, glass tubes, and syringes that can cause injury, spread infection, or pollute the environment when used or disposed of improperly

• HealthFirst - ODA Endorsed Program for amalgam recovery and sharps management
• Sharps Compliance, Inc - Serves all of Oregon
• MedPro Disposal - Serves the Portland Metro area and the Oregon Coast
• Critical Care Bio-Recovery LLC - Serves Multnomah County
• Mid-Valley Garbage Recycling Association - Serves Marion and Polk Counties
• Sanipac Recycling Disposal Services - Serves Lane County
• Bend Garabage and Recycling - Serves Bend, Prineville, Madras, and Redmond

Find a recycler
METRO provides a searchable directory of local businesses that recycle many different materials, including infectious and medical waste.

A health care provider will be able to apply for an NPI in one of three ways:

1. Apply through a web-based application process. You can access the application here.
2. Prepare and send a paper application form to the Enumerator. A copy of the application form, which includes the Enumerator's mailing address, is available here. Alternatively, you can call the Enumerator to request a blank application form at 1-800-465-3203 (toll-free) or 1-800-692-2326 (TTY).
3. With the permission of the health care provider, an organization may submit the provider's application in an electronic file.