Colorado Dental Board: News
- Proposed Opioid Guidelines Changes
- Dental Board 2019 Meeting Schedule
- Dental Rule XXVI Update
- New Law Affects Colorado Prescribers, Limits Opioid Prescriptions
- Fluoride Bill Expands DH Scope of Practice
- Revised Opioid Guidelines
- Training on Opioid Prescribing Available
- PDMP Delegate Training Video
- Changes to Disciplinary Procedures
- Mandatory Reporting Reminder
- Important PDMP Updates
- Free Access to PainNET System for Colorado Providers
- CE Requirements
The Board is soliciting feedback on proposed changes to the Guidelines for Prescribing and Dispensing Opioids (Guidelines), which were discussed at a September 2018 stakeholder meeting. Information has been added to the appendix and addresses new requirements in Senate Bill 18-22 Clinical Practice for Opioid Prescribing. This new state law went into effect on May 21, 2018, immediately upon the Governor’s signature. The law sets forth prescribing requirements, such as the number of opioids to be prescribed, and required Prescription Drug Monitoring Program checks in certain clinical situations. The law also provides specific exemptions to these requirements.
Final changes to the Guidelines will require formal adoption by the Division of Professions and Occupations’ (DPO) prescribing Boards - the Colorado Dental Board, the Colorado Medical Board, the State Board of Nursing, the State Board of Optometry, the Colorado Podiatry Board, and the State Board of Pharmacy, and an endorsement by the State Board of Veterinary Medicine.
The Guidelines were previously revised and released to the public in April 2018. The prescribing Boards under the Division’s auspices remain committed to ensuring that the document serves as a consistent reference that reflects best practices for stakeholders and any new laws the Boards must implement and enforce. To that end, DPO is requesting public feedback in order to fully review any impacts the most recent proposed changes may have on consumer protection.
If you have questions or would like to provide written comments on the proposed changes, please send them to Holli Weaver at firstname.lastname@example.org by December 15, 2018, at 5 p.m.
The Dental Board has released its meeting schedule for 2019. Download the 2019 meeting schedule.
The Dental Board Rules & Regulations have been updated. Rule XXVI, "Application of Silver Diamine Fluoride by Dental Hygienists" is effective August 14, 2018.
Note: The prescribing and dispensing Boards are reviewing Senate Bill 18-22 Clinical Practice for Opioid Prescribing, and considering its impact, if any, on the Guidelines for Prescribing and Dispensing Opioids. Please check back for updates.
On Monday, May 21, 2018, Governor John Hickenlooper signed Senate Bill 18-22 Clinical Practice for Opioid Prescribing. The bill went into effect immediately upon the Governor’s signature. This new state law limits the number of opioid pills a healthcare provider can prescribe and affects physicians, physician assistants, advanced practice registered nurses with prescriptive authority, dentists, optometrists, podiatrists, and veterinarians.
Under the new law, a prescriber must limit a patient’s initial prescription of an opioid to a seven-day supply, if the prescriber has not written an opioid prescription for the patient in the last 12 months. The prescriber may exercise discretion in including a second fill for a seven-day supply. These limits do not apply, if, in the judgment of the prescriber, the patient:
- Has chronic pain that typically lasts longer than 90 days or past the time of normal healing, as determined by the prescriber, or following transfer of care from another prescriber who prescribed an opioid to the patient;
- Has been diagnosed with cancer and is experiencing cancer related pain; or
- Is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days.
- Is undergoing palliative care or hospice care focused on providing the patient with relief from symptoms, pain and stress resulting from a serious illness in order to improve quality of life. (This exemption is allowed for physicians, physician assistants and advanced practice registered nurses only.)
After the first prescription, the prescriber is required to check the Prescription Drug Monitoring Program (PDMP) database before prescribing any additional opioids for the same patient. Failure to check the PDMP constitutes unprofessional conduct if the prescriber repeatedly fails to comply with this new requirement. The second fill requirement to check the PDMP does not apply when a patient:
- Is receiving the opioid in a hospital, skilled nursing facility, residential facility, or correctional facility;
- Has been diagnosed with cancer and is experiencing cancer related pain; or
- Is undergoing palliative care or hospice care;
- Is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days;
- Is receiving treatment during a natural disaster or during an incident where mass casualties have taken place; or has received only a single dose to relieve pain for a single test or procedure.
After the second opioid prescription, the law has no further restrictions on the healthcare provider’s prescribing practices. The new law does require a healthcare provider, or the provider’s designee, to specify the provider’s specialty upon the initial query of the PDMP. It also states a violation of the new requirements does not constitute negligence or contributory negligence per se and does not create a private right of action or serve as the basis of a cause of action.
Gov. John Hickenlooper signed House Bill 18-1045 Dental Hygienist Apply Silver Diamine Fluoride (HB18-1045). The bill became effective immediately upon the Governor’s signature on March 22, 2018 and expands the dental hygienist Scope of Practice by allowing dental hygienists to apply silver diamine fluoride under the direct or indirect supervision of a dentist if the dental hygienist:
- holds a license in good standing to practice dental hygiene;
- completes a postsecondary course on the use and limitations of silver diamine fluoride;
- is covered by professional liability insurance; and
- has a collaborative agreement with a dentist that outlines the protocol, any restrictions, and follow-up procedures for the use of silver diamine fluoride.
A dental hygienist may apply silver diamine fluoride only in collaboration with a dentist. The bill further outlines procedures for supervising dentists who are providing supervision from a separate location apart from the dental hygienist or via telehealth.
The bill also directs the Colorado Dental Board to create rules within 90 days of the effective date - June 22, 2018, in this instance. The Board has started implementing the bill and will draft rules as soon as possible. Implementation updates will be posted to the website, including details regarding a future stakeholder meeting to be held in early May. Please email email@example.com with any questions.
On March 16, 2018, the revised Guidelines for Prescribing and Dispensing Opioids were adopted by all six of Colorado’s prescribing and dispensing Boards: the Colorado Dental Board, the Colorado Medical Board, the State Board of Nursing, the State Board of Optometry, the Colorado Podiatry Board, and the State Board of Pharmacy, and endorsed by the State Board of Veterinary Medicine.
This revised Policy is a product of the collaboration between the seven Boards and a robust stakeholder engagement process. Stakeholder views, opinions and comments were essential in the revision of the 2014 Policy for Prescribing and Dispensing Opioids.
For dentists prescribing/dispensing opioids, the Colorado Dental Board recommends completing a continuing education course titled “The Opioid Crisis: Best Practices in Dentistry (for oral surgeons and dentists)”. The training program was developed by the Center for Health, Work & Environment at the Colorado School of Public Health in partnership with the Colorado Consortium for Prescription Drug Abuse Prevention and with input from several interested stakeholders. This 1-hour online, self-paced course will provide information to help you understand the significance of the opioid epidemic, understand the role of dentists, learn best practices and strategies for preventing prescription drug diversion and abuse, and identify tools and resources.
To access the training:
- Visit the Center for Health, Work & Environment website
- Scroll to the section labeled "Course for Dentistry Providers" and click "Enroll"
A new training video is available to show prescribers and pharmacists how to set up delegate accounts for the PDMP. Any prescriber or pharmacist can create up to three delegate accounts for trained individuals who can check the PDMP on the prescriber or pharmacist's behalf. You can utilize the PDMP more frequently to get the most complete medical history possible.
On June 6, 2017, Governor John Hickenlooper signed House Bill 17-1165 (HB17-1165) Department of Regulatory Agencies Boards Disciplinary Action Resolution Process. The new law became effective upon the Governor’s signature on June 6, 2017, and modifies the disciplinary procedures for six healthcare boards (prescriber boards) within the Division of Professions and Occupations in the Department of Regulatory Agencies (DORA). The prescriber boards affected include:
- Colorado Dental Board;
- Colorado Medical Board;
- State Board of Nursing;
- State Board of Optometry;
- Colorado Podiatry Board; and
- State Board of Veterinary Medicine.
As part of the bill’s implementation, we want to make sure you are aware of certain deadlines that affect the prescriber boards’ complaint processes and how you may need to respond to a board request. The following deadlines now apply unless a prescriber board has more protective provisions in current state law:
- Within 15 days of receipt of a complaint, the boards must provide the complainant with a written notice that includes contact information for the board, a summary of the complaint process and the complainant's rights, including a patient's right to receive a copy of his or her patient records.
- If relevant to a complaint, licensees must provide the board with patient records within 30 days of a board request for the records in the form of the response to a 30-day letter.
- If an investigation was initiated as a result of a complaint, and the board took public, formal action, the board must provide the complainant with written notice of the action within 30 days of the action.
- If a complaint is still pending after six months, the board must notify the complainant that the complaint is still pending, subject to applicable restrictions in state law.
- Each prescriber board is required to update its website within 30 days after suspending or revoking a license, listing each licensee subject to the suspension or revocation separately.
Finally, insurance carriers must now update their participating provider lists every 30 days to remove providers whose licenses have been suspended or revoked.
These deadlines are now in effect as required by state law. If you have questions about the new requirement or any other aspect of House Bill 17-1165, please contact Jo Donlin at firstname.lastname@example.org or 303-894-7434.
Did you know you are a mandatory reporter? Under Colorado law, more than 40 professions are required to report suspected child abuse and elder abuse. These professions include many regulated through the Division of Professions and Occupations (DPO) at DORA, such as:
- Physicians (including physician assistants and physicians in training);
- Dentists and dental hygienists;
- Nurses (including registered nurses, licensed practical nurses, and nurse practitioners);
- Nursing home administrators;
- Occupational therapists;
- Physical therapists;
- Mental health professionals (including psychologists, social workers, professional counselors, marriage and family therapists, registered psychotherapists and all candidates for licensure);
Online trainings help mandatory reporters recognize and report abuse, neglect, and exploitation. Licensees of the regulatory boards at DPO may accrue credit towards continuing education and continuing competency requirements for completing the trainings (should they exist for their profession).
Section 19-3-304, C.R.S. outlines the persons required by law to report child abuse and/or neglect. To assist mandatory reporters, a training is available on the Colorado Department of Human Services website at http://coloradocwts.com/mandated-reporter-training.
Section 18-6.5-108, C.R.S outlines the persons required by law to report abuse and exploitation of at-risk elders and at-risk adults with intellectual and developmental disabilities. Further information and an online training can be found on the Colorado Department of Human Services website at http://www.coloradoaps.com/about-mandatory-reporting-update.html.
If you have further questions regarding these requirements, please contact the Colorado Department of Human Services.
For questions regarding mandatory reporting of at-risk elders and at-risk adults with intellectual and developmental disabilities, please contact the Office of Community Access and Independence’s Division of Aging and Adult Services at email@example.com.
As we work together to tackle prescription drug misuse, abuse and diversion, we see PDMP utilization rates continue to increase as the database continues to serve as an important tool for meeting the standard of care for safe prescribing.
We are pleased to announce a new and improved PDMP website: colorado.gov/dora-pdmp. We listened to your challenges and ideas and hope you’ll find the new website easier to navigate and more relevant to your needs. You will be able to link to your PDMP account and access other information directly from the homepage. We also selected a new vendor, APPRISS, and will be utilizing the PMP AWARxE system. The database interface will look different and make PDMP queries easier and quicker. We encourage your continued feedback for ongoing improvement efforts.
New State Law Improves Access to PDMP
To make the PDMP more accessible and easier for health professionals to incorporate into daily use, the Colorado General Assembly passed legislation in 2017. On April 6, 2017, Governor John Hickenlooper signed Senate Bill 17-146 Access To Prescription Drug Monitoring Program, which clarifies health professionals' access to the PDMP database by:
- Allowing a health care provider with prescribing authority to query the PDMP about a current patient, including checking on drug interactions and side effects, thus making the PDMP an even more useful tool for health professionals in their clinical decision-making for patients;
- Allowing a veterinarian with prescribing authority to query the PDMP about a current client if the veterinarian has a reasonable basis to suspect the client has committed drug abuse or has mistreated an animal; and
- Allowing a pharmacist to query the PDMP about a current patient for whom the pharmacist is dispensing any prescription drug, rather than only patients receiving controlled substances.
The law became effective immediately, and the Division is working with the appropriate Boards to implement the new law including rulemaking, outreach and education. If you have questions about the Colorado PDMP, please contact Division staff at 303-894-5957 or firstname.lastname@example.org. If you need technical assistance with the PMP AWARxE system, please contact the vendor help desk at 1-855-263-6403.
The Colorado Department of Health Care Policy and Financing (HCPF) worked with the vendor of its Project ECHO Pain Management Program, Community Health Center, to expand access to the program website known as PainNET.
The PainNet website is an online learning community that aims to improve pain care expertise among primary care providers. The website is also available to other Health First Colorado (Colorado’s Medicaid Program) primary care medical providers (PCMPs) for free.
The PainNET learning community enables PCMPs to develop expertise to treat patients with complex chronic pain through a combination of archived Project ECHO Pain case presentations, resource libraries, community forums and expert consultations. Providers and specialists are able to communicate through discussion boards, chat rooms and direct messaging.
This is a great resource for Colorado providers to access resources that can increase their knowledge on how to manage chronic pain more effectively.
Learn More About PainNET
- Download the PainNET Access flyer.
- Watch the Introduction to PainNET video.
- Sign up for access by contacting Agi Erickson at email@example.com.
- Contact JD Belshe, Consultant/Policy & Program Analyst for HCPF, at firstname.lastname@example.org for any other questions about the PainNET program.
Every licensed dentist or licensed dental hygienist must complete 30 hours of Board approved continuing education during the two years preceding the next renewal period, which ends on the last day of February of every even year. All licensed dentists, dentists with an academic license, and licensed dental hygienists who are renewing an active license must meet these requirements. Licensees can start accumulating Board approved CE hours on or after March 1 of every even year and they must be completed by the last day of February of every even year in order to apply them to the renewal period.
Anyone interested in learning about the detailed requirements should review Rule III(G), including the types of continuing education that are accepted.
If you have questions, please contact the Colorado Dental Board staff at email@example.com.