reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › ADMINISTRATION OF ANESTHETIC AGENTS FOR DENTAL PROCEDURES › Section 246-817-775 - On-site inspections

Current through Register Vol. 24-14, July 15, 2024
(1) A licensed
				  dentist shall conduct a self-assessment of their office preparedness for
				  emergencies, proper emergency equipment, and emergency drugs annually. The
				  annual self-assessment attestation must be maintained for five years.
(2) A licensed dentist who holds a valid
				  moderate sedation with parenteral agents or general anesthesia permit shall
				  conduct a self-inspection using the appropriate DQAC's on-site inspection form
				  annually. The annual self-inspection form shall be maintained for five
				  years.
(3) A licensed dentist who
				  holds a moderate sedation with parenteral agents or general anesthesia permit
				  must:
(a) Obtain an on-site inspection every
				  five years at the location where moderate sedation with parenteral agents or
				  general anesthesia is provided by an approved organization or by a
				  self-arranged inspection using the DQAC approved on-site inspection form.
(i) The self-arranged on-site inspection must
				  be completed by at least two providers with the same or higher level permit as
				  the licensed dentist being evaluated.
(ii) Volunteer evaluators may be a certified
				  registered nurse anesthetist, licensed physician anesthesiologist, or a
				  licensed dentist who holds an appropriate moderate sedation with parenteral
				  agents or general anesthesia permit for at least five years.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › ADMINISTRATION OF ANESTHETIC AGENTS FOR DENTAL PROCEDURES › Section 246-817-776 - Discharge criteria for all levels of sedation or general anesthesia

Current through Register Vol. 24-14, July 15, 2024
The licensed dentist shall ensure an anesthesia provider
					 assesses patient responsiveness using preoperative values as normal guidelines
					 and discharge the patient only when the following criteria are met, except when
					 their prior baseline is below the noted criteria:
(1) Vital signs including blood pressure,
				  pulse rate and respiratory rate are stable. Vital signs are not required when:
(a) A pediatric ASA I or ASA II patient is
				  undergoing a routine dental procedure using either local anesthetic, nitrous
				  oxide, or both with no other sedating medications; or
(b) A pediatric patient is uncooperative or
				  the emotional condition is such that obtaining vital signs is not
				  possible.
(c) Reasons why vital
				  signs were not obtained must be documented.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › ADMINISTRATION OF ANESTHETIC AGENTS FOR DENTAL PROCEDURES › Section 246-817-778 - Nondentist anesthesia providers

Current through Register Vol. 24-14, July 15, 2024
(1)
				  A licensed dentist shall have a contract in place when working with a
				  nondentist anesthesia provider. The contract must include:
(a) That all facility, equipment, monitoring,
				  and training requirements, for all personnel required in WAC
				  246-817-701 through
				  246-817-790 have been
				  met.
(b) That the anesthesia
				  provider is responsible for the pre, intra, postoperative, and discharge
				  anesthetic management of the patient.
(c) Delineation of responsibilities. The
				  dentist and the anesthesia provider shall agree upon and arrange for the
				  provision of items such as facility, equipment, monitoring, and training
				  requirements to be met by either party. The dentist and the anesthesia provider
				  shall establish written emergency protocols, as required in WAC
				  246-817-724, and all clinical
				  staff must be trained.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › ADMINISTRATION OF ANESTHETIC AGENTS FOR DENTAL PROCEDURES › Section 246-817-780 - Mandatory reporting

Current through Register Vol. 24-14, July 15, 2024
A licensed dentist shall submit a report of any patient
					 death or other life-threatening incident or complication, permanent injury or
					 admission to a hospital that results in a stay at the hospital for more than 24
					 hours, which is or may be a result of a dental procedure caused by a dentist or
					 dental treatment.
(1) A licensed
				  dentist shall notify the DQAC, by telephone, email, or facsimile within 72
				  hours of discovery and must submit a complete written report to the DQAC within
				  30 days of the incident.
(2) When a
				  patient comes into an office with an existing condition, and hospital admission
				  is the result of that condition and not the dental procedure, it is not
				  reportable.
(3) The written report
				  must include the following:
(a) Name, age, and
				  address of the patient.
(b) Name of
				  the dentist and other personnel present during the incident.
(c) Address of the facility or office where
				  the incident took place.
(d)
				  Description of the type of sedation or anesthetic being utilized at the time of
				  the incident.
(e) Dosages, if any,
				  of drugs administered to the patient.
(f) A narrative description of the incident
				  including approximate times and evolution of symptoms.
(g) Hospital discharge records if
				  available.
(h) Additional
				  information which the DQAC may require or request.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › ADMINISTRATION OF ANESTHETIC AGENTS FOR DENTAL PROCEDURES › Section 246-817-790 - Application of chapter 18.130 RCW

Current through Register Vol. 24-14, July 15, 2024
The provisions of the Uniform Disciplinary Act, chapter
					 18.130 RCW, apply to the permits and endorsements of authorization that may be
					 issued and renewed under this chapter.
Statutory Authority: RCW 18.32.035. 95-21-041, §
						246-817-790, filed 10/10/95, effective
						11/10/95.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › SUBSTANCE ABUSE MONITORING PROGRAMS › Section 246-817-801 - Intent

Current through Register Vol. 24-14, July 15, 2024
It is the intent of the legislature that the DQAC seek ways
					 to identify and support the rehabilitation of dentists where practice or
					 competency may be impaired due to an applicable impairing or potentially
					 impairing health condition. The legislature intends that these dentists be
					 treated so that they can return to or continue to practice dentistry in a way
					 which safeguards the public. The legislature specifically intends that the DQAC
					 establish an alternate program to the traditional administrative proceedings
					 against such dentists.
In lieu of disciplinary action under
					 RCW
					 18.130.160 and if the DQAC determines that
					 the unprofessional conduct may be the result of an applicable impairing or
					 potentially impairing health condition, the DQAC may refer the license holder
					 to a physician health program or a voluntary substance use disorder monitoring
					 program approved by the DQAC.
Statutory Authority: RCW 18.32.035. 95-21-041, §
						246-817-801, filed 10/10/95, effective
						11/10/95.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › SUBSTANCE ABUSE MONITORING PROGRAMS › Section 246-817-810 - Terms used in WAC 246-817-801 through 246-817-830

Current through Register Vol. 24-14, July 15, 2024
"Aftercare"
is that period of time after
					 intensive treatment that provides the dentist or the dentist's family with
					 group or individual counseling sessions, discussions with other families,
					 ongoing contact and participation in self-help groups, and ongoing continued
					 support of treatment and/or monitoring program staff.
"Approved substance use disorder monitoring
					 program"
or
"approved physician health monitoring program"
is a program the DQAC has determined meets the requirements of the law and the
					 criteria established by the DQAC in the Washington Administrative Code which
					 enters into a contract with dentists who have substance use disorders or other
					 potentially impairing health conditions regarding the required components of
					 the dentist's recovery activity and oversees the dentist's compliance with
					 these requirements. Substance use disorder or other potentially impairing
					 health conditions monitoring programs may provide evaluation or treatment to
					 participating dentists.
"Approved treatment facility"
is a facility
					 approved by the bureau of alcohol and substance abuse, department of social and
					 health services according to
					 RCW
					 18.130.175.
"Contract"
is a comprehensive, structured
					 agreement between the recovering dentist and the approved physician health
					 program or substance use disorder monitoring program wherein the dentist
					 consents to comply with the physician health program or substance use disorder
					 monitoring program and the required components for the dentist's recovery
					 activity.
"Dentist support group"
is a group of dentists
					 and/or other health professionals meeting regularly to support the recovery of
					 its members. The group provides a confidential setting with a trained and
					 experienced facilitator in which participants may safely discuss drug
					 diversion, licensure issues, return to work, and other professional issues
					 related to recovery.
"Random drug screens"
are laboratory tests to
					 detect the presence of drugs of abuse in bodily fluids collected under
					 observation which are performed at irregular intervals not known in advance by
					 the person to be tested.
"Substance use disorder"
is the impairment, as
					 determined by the DQAC, of a dentist's professional services by an addiction
					 to, a dependency on, or the use of alcohol, legend drugs, or controlled
					 substances.
"Twelve-steps groups"
are groups such as
					 Alcoholics Anonymous, Narcotics Anonymous, and related organizations based on a
					 philosophy of anonymity, belief in a power outside of oneself, peer group
					 association, and self-help.
Statutory Authority: RCW 18.32.035. 95-21-041, §
						246-817-810, filed 10/10/95, effective
						11/10/95.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › SUBSTANCE ABUSE MONITORING PROGRAMS › Section 246-817-820 - Approval of physician health programs or substance use disorder monitoring programs

Current through Register Vol. 24-14, July 15, 2024
The DQAC will approve the physician health program or
					 substance use disorder monitoring program(s) which will participate in the
					 recovery of dentists. The DQAC will enter into a contract with the approved
					 physician health program or substance use disorder monitoring program(s) on an
					 annual basis.
(1) An approved
				  physician health program or substance use disorder monitoring program may
				  provide evaluations and/or treatment to the participating dentists.
(2) An approved physician health program or
				  substance use disorder monitoring program staff must have the qualifications
				  and knowledge of both substance use disorders, other potentially impairing
				  health conditions, and the practice of dentistry as defined in this chapter to
				  be able to evaluate:
(a) Drug screening
				  laboratories;
(b) Laboratory
				  results;
(c) Providers of substance
				  abuse treatment for substance use disorders or other potentially impairing
				  health conditions, both individual and facilities;
(d) Dentists' support groups;
(e) The dentists' work environment;
				  and
(f) The ability of the dentist
				  to practice with reasonable skill and safety.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-General Provisions › Section 246-817-901 - Intent and scope

Current through Register Vol. 24-14, July 15, 2024
WAC 246-817-901 through 246-817-980 govern the
						prescribing of opioids in the treatment of pain.
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-901, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-General Provisions › Section 246-817-905 - Exclusions

Current through Register Vol. 24-14, July 15, 2024
WAC
						246-817-901
						through 246-817-980 do not apply to:
(1) The treatment of patients with
					 cancer-related pain. Cancer-related pain means pain that is unpleasant,
					 persistent, subjective sensory and emotional experience associated with actual
					 or potential tissue injury or damage or described in such terms and is related
					 to cancer or cancer treatment that interferes with usual functioning;
(2) The provision of palliative, hospice, or
					 other end-of-life care;
(3) The
					 treatment of inpatient hospital patients. Inpatient means a person who has been
					 admitted to the hospital for more than twenty-four hours; or
(4) The provision of procedural
					 medications.
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-905, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-General Provisions › Section 246-817-907 - Patient notification, secure storage, and disposal

Current through Register Vol. 24-14, July 15, 2024
(1) The dentist shall discuss with the
					 patient educating them of risks associated with the use of opioids, including
					 the risk of dependence and overdose. The dentist shall document such
					 notification in the patient record.
(2) Patient notification must occur, at a
					 minimum, at the following points of treatment:
(a) The first issuance of a prescription for
					 an opioid; and
(b) The transition
					 between phase of treatment, as follows:
(i)
					 Acute nonoperative pain or acute perioperative pain to subacute pain; and
(ii) Subacute pain to chronic
					 pain.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-General Provisions › Section 246-817-908 - Use of alternative modalities for pain treatment

Current through Register Vol. 24-14, July 15, 2024
The dentist shall consider multimodal phar-macologic and
						nonpharmacologic therapy for pain rather than defaulting to the use of opioid
						therapy alone whenever reasonable, evidence-based, clinically appropriate
						alternatives exist.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-General Provisions › Section 246-817-909 - Continuing education requirements for opioid prescribing

Current through Register Vol. 24-14, July 15, 2024
(1) In order to prescribe an opioid in
					 Washington state, a dentist licensed to prescribe opioids shall complete a
					 one-time continuing education requirement regarding best practices in the
					 prescribing of opioids and the rules in this chapter. The continuing education
					 must be at least three hours in length.
(2) The dentist shall complete the one-time
					 continuing education requirement described in subsection (1) of this section by
					 the end of the dentist's first full continuing education reporting period after
					 January 1, 2019, or during the first full continuing education reporting period
					 after initial licensure, whichever is later.
(3) The hours spent completing the training
					 in opioid prescribing under this section count toward meeting applicable
					 continuing education requirements for dentist license renewal.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-General Provisions › Section 246-817-910 - Definitions (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-910, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-General Provisions › Section 246-817-911 - Diagnosis identified on prescription

Current through Register Vol. 24-14, July 15, 2024
The practitioner shall include the diagnosis, indication
						for use, or the International Classification of Diseases (ICD) code on all
						opioid prescriptions.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Acute Nonoperative Pain and Acute Perioperative Pain › Section 246-817-913 - Treatment plan-Acute nonoper-ative pain and acute perioperative pain

Current through Register Vol. 24-14, July 15, 2024
The dentist shall comply with the requirements in this
						section when prescribing opioid analgesics for acute nonoperative pain or acute
						perioperative pain and shall document completion of these requirements in the
						patient record:
(1) The dentist shall
					 consider prescribing nonopioid analgesics as the first line of pain control in
					 patients in accordance with the provisions of WAC 246-817-908 unless not
					 clinically appropriate.
(2) The
					 dentist, or their designee, shall conduct queries of the PMP in accordance with
					 the provisions of WAC 246-817-980 to identify any Schedule II-V medications or
					 drugs of concern received by the patient and document their review and any
					 concerns in the patient record.
(3)
					 If the dentist prescribes opioids for effective pain control, such prescription
					 must not be in a greater quantity than needed for the expected duration of pain
					 severe enough to require opioids.
(a) A
					 three-day supply or less will often be sufficient;
(b) More than a seven-day supply will rarely
					 be needed;
(c) The dentist shall
					 not prescribe beyond a seven-day supply without clinical documentation in the
					 patient record to justify the need for such a quantity. For more specific best
					 practices, the dentist may refer to clinical practice guidelines including, but
					 not limited to, those produced by the agency medical directors' group, the
					 Centers for Disease Control and Prevention, or the Bree
					 collaborative.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Subacute Pain › Section 246-817-915 - Patient evaluation and patient record

Current through Register Vol. 24-14, July 15, 2024
The dentist shall comply with the requirements in this
						section when prescribing opioid analgesics for subacute pain, and shall
						document completion of these requirements in the patient record:
(1) Prior to prescribing an opioid for
					 subacute pain, the dentist shall:
(a) Conduct
					 an appropriate history and physical examination or review and update the
					 patient's existing history and examination taken during the acute nonoperative
					 or acute perioperative phase;
(b)
					 Evaluate the nature and intensity of the pain;
(c) Inquire about other medications the
					 patient is prescribed or taking, including date, type, dosage, and quantity
					 prescribed;
(d) Conduct, or cause
					 their designee to conduct, a query of the PMP in accordance with the provisions
					 of WAC 246-817-980 to identify any Schedule II-V medications or drugs of
					 concern received by the patient and document in their review and any
					 concerns;
(e) Obtain a biological
					 specimen test if the patient's function is deteriorating or if pain is
					 escalating; and
(f) Screen or refer
					 the patient for further consultation for psychosocial factors which may be
					 impairing recovery including, but not limited to, depression or
					 anxiety.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Subacute Pain › Section 246-817-916 - Treatment plan-Subacute pain

Current through Register Vol. 24-14, July 15, 2024
(1)
					 The dentist shall recognize the progression of a patient from the acute
					 nonoperative or acute perioperative phase to the subacute phase and take into
					 consideration the risks and benefits of continued opioid prescribing for the
					 patient.
(2) If tapering has not
					 begun prior to the six- to twelve-week subacute phase, the dentist shall
					 reevaluate the patient who does not follow the expected course of recovery. If
					 significant and documented improvement in function or pain control has not
					 occurred, the dentist shall reconsider the continued use of opioids or whether
					 tapering or discontinuing opioids is clinically indicated. The dentist shall
					 make reasonable attempts to discontinue the use of opioids prescribed for the
					 acute pain event by no later than the twelve-week conclusion of the subacute
					 phase.
(3) If the dentist
					 prescribes opioids for effective pain control, such prescriptions must not be
					 in a greater quantity than needed for the expected duration of pain severe
					 enough to require opioids. The dentist shall not prescribe beyond a
					 fourteen-day supply of opioids without clinical documentation to justify the
					 need for such a quantity during the subacute phase.
(4) If the dentist elects to prescribe a
					 combination of opi-oids with a medication listed in WAC 246-817-975 or
					 prescribes opioids to a patient known to be receiving a medication listed in
					 WAC 246-817-975 from another practitioner, the dentist shall prescribe in
					 accordance with WAC 246-817-975.
(5) If the dentist elects to treat a patient
					 with opioids beyond the six- to twelve-week subacute phase, the dentist shall
					 document in the patient record that the patient is transi-tioning from subacute
					 pain to chronic pain. Rules governing the treatment of chronic pain in WAC
					 246-817-919 through 246-817-967, shall apply.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-919 - Patient evaluation and patient record

Current through Register Vol. 24-14, July 15, 2024
The dentist shall evaluate and document the patient's
						health history and physical examination in the patient record prior to treating
						for chronic pain.
(1) History. The
					 patient's health history must include:
(a)
					 The nature and intensity of the pain;
(b) The effect of pain on physical and
					 psychosocial function;
(c) Current
					 and past treatments for pain, including medications and their
					 efficacy;
(d) Review of any
					 significant comorbidities;
(e) Any
					 current or historical substance use disorder;
(f) Current medications and, as related to
					 treatment of the pain, the efficacy of medications tried; and
(g) Medication allergies.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-920 - Treatment plan

Current through Register Vol. 24-14, July 15, 2024
(1) When the
					 patient enters the chronic pain phase, the dentist shall reevaluate the patient
					 by treating the situation as a new disease.
(2) The chronic pain treatment plan must
					 state the objectives that will be used to determine treatment success and must
					 include, at a minimum:
(a) Any change in pain
					 relief;
(b) Any change in physical
					 and psychosocial function; and
(c)
					 Additional diagnostic evaluations or other planned treatments.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-925 - Informed consent (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-925, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-930 - Written agreement for treatment

Current through Register Vol. 24-14, July 15, 2024
The dentist shall use a written agreement for treatment
						with the patient who requires long-term opioid therapy for chronic pain that
						outlines the patient's responsibilities. This written agreement for treatment
						must include:
(1) The patient's
					 agreement to provide biological samples for biological specimen testing when
					 requested by the dentist;
(2) The
					 patient's agreement to take medications at the dose and frequency prescribed
					 with a specific protocol for lost prescriptions and early refills or renewals.
					 "Refill" or "renewal" means a second or subsequent filling of a previously
					 issued prescription that is authorized to be dispensed when the patient has
					 exhausted their current supply. For the purposes of WAC
					 246-817-901
					 through 246-817-980, refills or renewals are subject to the same limitation and
					 requirements as initial prescriptions;
(3) Reasons for which opioid therapy may be
					 discontinued such as, but not limited to, violation of agreement;
(4) The requirement that all chronic opioid
					 prescriptions are provided by a single pre-scriber, a single clinic, or
					 multidisciplinary pain clinic;
(5)
					 The requirement that all chronic opioid prescriptions are to be dispensed by a
					 single pharmacy or pharmacy system whenever possible;
(6) The patient's agreement to not abuse
					 substances that can put the patient at risk for adverse outcomes;
(7) A written authorization for:
(a) The dentist to release the agreement for
					 treatment to:
(i) Local emergency
					 departments;
(ii) Urgent care
					 facilities;
(iii) Other
					 practitioners caring for the patient who might prescribe pain medications;
					 and
(iv) Pharmacies.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-935 - Periodic review

Current through Register Vol. 24-14, July 15, 2024
(1) The dentist
					 shall periodically review the course of treatment for chronic pain. The
					 frequency of visits, biological testing, and PMP queries must be determined
					 based on the patient's risk category:
(a) For
					 a high-risk patient, at least quarterly;
(b) For a moderate-risk patient, at least
					 semiannually;
(c) For a low-risk
					 patient, at least annually;
(d)
					 Immediately upon indication of concerning aberrant behavior; and
(e) More frequently at the dentist's
					 discretion.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-940 - Long-acting opioids, including metha-done (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-940, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-945 - Episodic care (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-945, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-950 - Consultation-Recommendations and requirements

Current through Register Vol. 24-14, July 15, 2024
(1) The
					 dentist shall consider referring the patient for additional evaluation and
					 treatment as needed to achieve treatment objectives. Special attention should
					 be given to those chronic pain patients who are under eighteen years of age or
					 who are potential high-risk patients. The management of pain in patients with a
					 history of substance abuse or with comorbid psychiatric disorders may require
					 extra care, monitoring, documentation, and consultation with, or referral to,
					 an expert in the management of such patients.
(2) The mandatory consultation threshold is
					 one hundred twenty MED. Unless the consultation is exempted under WAC
					 246-817-955
					 or
					 246-817-960,
					 the dentist who prescribes a dosage amount that meets or exceeds the mandatory
					 consultation threshold shall comply with the pain management specialist
					 consultation requirements described in WAC
					 246-817-965.
The mandatory consultation must consist of at least one
						of the following:
(a) An office visit
					 with the patient and the pain management specialist;
(b) A consultation between the pain
					 management specialist and the dentist;
(c) An audio-visual evaluation conducted by
					 the pain management specialist remotely, where the patient is present with
					 either the dentist or with a licensed health care practitioner designated by
					 the dentist or the pain management specialist; or
(d) Other chronic pain evaluation services as
					 approved by the dental quality assurance commission.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-955 - Consultation-Exemptions for exigent and special circumstances

Current through Register Vol. 24-14, July 15, 2024
A dentist is not required to consult with a pain
						management specialist as described in WAC
						246-817-965
						when the dentist has documented adherence to all standards of practice as
						defined in WAC 246-817-919 through 246-817-967 and when one or more of the
						following conditions are met:
(1) The
					 patient is following a tapering schedule;
(2) The patient requires treatment for acute
					 pain, which may or may not include hospitalization, requiring a temporary
					 escalation in opioid dosage with expected return to their baseline dosage level
					 or below;
(3) The dentist documents
					 reasonable attempts to obtain a consultation with a pain management specialist
					 and the circumstances justifying prescribing above one hundred twenty
					 milligrams MED per day without first obtaining a consultation; or
(4) The dentist documents the patient's pain
					 and function is stable and the patient is on a nonescalat-ing dosage of
					 opioids.
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-955, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-960 - Consultation-Exemptions for the dentist

Current through Register Vol. 24-14, July 15, 2024
The dentist is exempt from the consultation requirement
						in WAC
						246-817-950
						if one or more of the following qualifications are met:
(1) The dentist is a pain management
					 specialist under WAC
					 246-817-965;
(2) The dentist has successfully completed
					 every four years a minimum of twelve continuing education hours on chronic pain
					 management , with at least two of these hours dedicated substance use
					 disorders;
(3) The dentist is a
					 pain management practitioner working in a multidisciplinary chronic pain
					 treatment center or a multidisciplinary academic research facility;
					 or
(4) The dentist has a minimum
					 three years of clinical experience in a chronic pain management setting, and at
					 least thirty percent of their current practice is the direct provision of pain
					 management care.
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-960, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-965 - Pain management specialist

Current through Register Vol. 24-14, July 15, 2024
A pain management specialist shall meet the following
						qualifications:
(1) A dentist shall be
					 board certified or board eligible in oral medicine or orofacial pain by the
					 American Board of Oral Medicine or the American Board of Oro-facial
					 Pain.
(2) An allopathic physician
					 shall meet requirements in WAC
					 246-919-945
					 and an allopathic physician assistant shall meet requirements in WAC
					 246-918-895.
(3) An osteopathic physician shall meet
					 requirements in WAC
					 246-853-750
					 and an osteopathic physician assistant shall meet requirements in WAC
					 246-854-330.
(4) An advanced registered nurse practitioner
					 (ARNP) shall meet requirements in WAC
					 246-840-493.
(5) A podiatric physician shall meet
					 requirements in WAC
					 246-922-750.
Statutory Authority:
						  RCW
						  18.32.785 and
						  18.32.0365. 11-10-061, §
						  246-817-965, filed 5/2/11, effective
						  7/1/11.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-966 - Assessment of treatment plan

Current through Register Vol. 24-14, July 15, 2024
(1) The
					 dentist shall assess and document the appropriateness of continued use of the
					 current treatment plan if the patient's response to or compliance with the
					 current treatment plan is unsatisfactory.
(2) The dentist shall consider tapering,
					 changing, discontinuing treatment, or referral for a substance use disorder
					 evaluation when:
(a) The patient
					 requests;
(b) The patient
					 experiences deterioration in function or pain;
(c) The patient is noncompliant with the
					 written agreement;
(d) Other
					 treatment modalities are indicated;
(e) There is evidence of misuse, abuse,
					 substance use disorder, or diversion;
(f) The patient experiences a severe adverse
					 event or overdose;
(g) There is
					 unauthorized escalation of doses; or
(h) The patient is receiving an escalation in
					 opioid dosage with no improvement in pain, function, or quality of
					 life.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Chronic Pain Management › Section 246-817-967 - Patients with chronic pain, including those on high doses, establishing a relationship with a new dentist

Current through Register Vol. 24-14, July 15, 2024
(1) When a
					 patient receiving chronic opi-oid pain medications changes to a new dentist, it
					 is normally appropriate for the new dentist to initially maintain the patient's
					 current opioid doses. Over time, the dentist may evaluate if any tapering or
					 other adjustments in the treatment plan can or should be done.
(2) A dentist's treatment of a new high dose
					 chronic pain patient is exempt from the mandatory consultation requirements of
					 WAC
					 246-817-950
					 and the tapering requirements of WAC 246-817-966 if:
(a) The patient was previously being treated
					 with a dosage of opioids in excess of one hundred twenty milligram MED for
					 chronic pain under an established written agreement for treatment of the same
					 chronic condition or conditions;
(b) The patient's dose is stable and
					 nonescalating;
(c) The patient has
					 a demonstrated history in their record of compliance with treatment plans and
					 written agreements as documented by medical records and PMP queries;
					 and
(d) The patient has documented
					 functional stability, pain control, or improvements in function or pain
					 control, in excess of one hundred twenty milligram MED dose.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Special Populations › Section 246-817-970 - Special populations-Patients twenty-four years of age or under, pregnant patients, and aging populations

Current through Register Vol. 24-14, July 15, 2024
(1)
					 Patients twenty-four years of age or under. In the treatment of pain for
					 patients twenty-four years of age or under, the dentist shall treat pain in a
					 manner equal with that of an adult but must account for the weight of the
					 patient and adjust the dosage prescribed accordingly. Eight to twelve tablets
					 supply will often be sufficient. The dentist shall not prescribe beyond twelve
					 tablets without clinical documentation in the patient record to justify the
					 need for such a quantity.
(2)
					 Pregnant patients. A dentist shall not discontinue use of MAT opioids, such as
					 methadone or buprenorphine, by a pregnant patient without oversight by the MAT
					 prescribing practitioner. The dentist shall weigh carefully the risks and
					 benefits of opioid detoxification during pregnancy.
(3) Aging populations. As people age, their
					 tolerance and metabolizing of opioids may change. The dentist shall consider
					 the distinctive needs of patients who are sixty-five years of age or older and
					 who have been on chronic opioid therapy or who are initiating opioid
					 treatment.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Special Populations › Section 246-817-971 - Episodic care of chronic opioid patients

Current through Register Vol. 24-14, July 15, 2024
(1) When providing episodic care for a
					 patient who the dentist knows is being treated with opioids for chronic pain,
					 such as for emergency or urgent care, the dentist shall review the PMP to
					 identify any Schedule II-V or drugs of concern received by the patient and
					 document in the patient record their review and any concerns.
(2) A dentist providing episodic care to a
					 patient who the dentist knows is being treated with opioids for chronic pain
					 should provide additional opioids to be equal to the severity of the acute
					 pain. If opioids are provided, the dentist shall limit the use of opioids to
					 the minimum amount necessary to control the acute nonoperative pain, acute
					 perioperative pain, or similar acute exacerbation of pain until the patient can
					 receive care from the practitioner who is managing the patient's chronic pain
					 treatment.
(3) The episodic care
					 dentist shall report known violations of the patient's written agreement to the
					 patient's treatment practitioner who provided the agreement for
					 treatment.
(4) The episodic care
					 dentist shall coordinate care with the patient's chronic pain treatment
					 practitioner if that person is known to the episodic care dentist, when
					 practicable.
(5) For the purpose of
					 this section "episodic care" means medical or dental care provided by a
					 practitioner other than the designated primary care practitioner in the acute
					 care setting; for example, urgent care or emergency department.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Coprescribing › Section 246-817-975 - Coprescribing of opioids with certain medications

Current through Register Vol. 24-14, July 15, 2024
(1) The dentist shall not knowingly prescribe
					 opioids in combination with the following Schedule II-IV medications without
					 documentation of clinical judgment and discussion of risks with patient:
(a) Benzodiazepines;
(b) Barbiturates;
(c) Sedatives;
(d) Carisoprodol; or
(e) Sleeping medications also known as Z
					 drugs.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Coprescribing › Section 246-817-976 - Coprescribing of opioids for patients receiving medication assisted treatment

Current through Register Vol. 24-14, July 15, 2024
(1) Where
					 practicable, the dentist providing acute nonoperative pain or acute
					 perioperative pain treatment to a patient known to be receiving MAT shall
					 prescribe opioids for pain relief either in consultation with the MAT
					 prescribing practitioner or a pain specialist.
(2) A dentist shall not discontinue MAT
					 medications when treating acute nonoperative pain or acute perioperative pain
					 without documentation of the reason for doing so.
(3) A dentist shall not deny necessary
					 operative intervention for use of these medications by a patient.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Coprescribing › Section 246-817-977 - Coprescribing of naloxone

Current through Register Vol. 24-14, July 15, 2024
The dentist shall confirm or provide a current
						prescription for nal-oxone or refer the patient to a pharmacist for further
						counseling and evaluation when opioids are prescribed to a high-risk
						patient.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-Prescribing Monitoring Program › Section 246-817-980 - Prescription monitoring program-Required registration, queries, and documentation

Current through Register Vol. 24-14, July 15, 2024
(1) The
					 dentist shall register to access the PMP or demonstrate proof of having assured
					 access to the PMP if they prescribe opioids in Washington state.
(2) The dentist is permitted to delegate
					 performance of a required PMP query to an authorized designee.
(3) At a minimum, the dentist shall ensure a
					 PMP query is performed prior to the prescription of an opioid at the following
					 times:
(a) Upon the first refill or renewal
					 of an opioid prescription for acute nonoperative pain or acute perioperative
					 pain;
(b) The time of transition
					 from acute to subacute pain; and
(c) The time of transition from subacute to
					 chronic pain.
Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › FEES › Section 246-817-990 - Dentist fees and renewal cycle

Current through Register Vol. 24-14, July 15, 2024
(1) Licenses must
				  be renewed every year on the practitioner's birthday as provided in chapter
				  246-12 WAC, except faculty and resident licenses.
(2) Faculty and resident licenses must be
				  renewed every year on July 1 as provided in chapter 246-12 WAC.
(3) The following nonrefundable fees will be
				  charged:
Title of Fee
Fee
Original application by
								examination*
Initial application
$500.00
Original application - Without
								examination
Initial application
500.00
Initial license
500.00
Faculty license application
500.00
Resident license application
115.00
Active license renewal:
Renewal
365.00
Surcharge - Impaired dentist
50.00
Late renewal penalty
185.00
Expired license reissuance
300.00
Inactive license renewal:
Renewal
125.00
Surcharge - Impaired dentist
50.00
Late renewal penalty
50.00
Retired active license renewal
Renewal
150.00
Surcharge - Impaired dentist
50.00
Late renewal penalty
75.00
Duplicate license
15.00
Certification of license
25.00
Anesthesia permit
Initial application
150.00
Renewal - (Three-year renewal cycle)
160.00
Late renewal penalty
80.00
Expired permit reissuance
50.00
On-site inspection fee
To be determined by future rule adoption.
* In addition to the initial application fee above,
					 applicants for licensure via examination will be required to submit a separate
					 application and examination fee directly to the dental testing agency accepted
					 by the dental quality assurance commission.
Statutory
					 Authority:
					 RCW
					 43.70.110,
					 43.70.250, and 2010 c 37 . WSR
					 10-19-071, § 246-817-990, filed 9/16/10, effective 10/15/10. Statutory
					 Authority:
					 RCW
					 43.70.110,
					 43.70.250 and 2008 c 329. WSR
					 08-16-008, § 246-817-990, filed 7/24/08, effective 7/25/08. Statutory
					 Authority:
					 RCW
					 43.70.250, [43.70.]280 and 43.70.110. WSR
					 05-12-012, § 246-817-990, filed 5/20/05, effective 7/1/05. Statutory
					 Authority:
					 RCW
					 18.32.0365 and
					 43.70.250. WSR 01-11-166, §
					 246-817-990, filed 5/23/01, effective 7/1/01. Statutory Authority:
					 RCW
					 43.70.250. WSR 99-08-101, § 246-817-990,
					 filed 4/6/99, effective 7/1/99. Statutory Authority:
					 RCW
					 43.70.280. WSR 98-05-060, § 246-817-990,
					 filed 2/13/98, effective 3/16/98. Statutory Authority:
					 RCW
					 43.70.040. WSR 95-16-122, § 246-817-990,
					 filed 8/2/95, effective 9/1/95. WSR 13-21-003, § 246-817-990, filed
					 10/3/2013, effective 11/3/2013