Regulations & Statutes

Below you will find both State and Federal Regulations and Statutes.

State Regulations

Backflow Prevention and the Connecticut Dental Office

The Connecticut Department of Public Health (DPH) requires all Connecticut dental offices to have backflow prevention devices installed. Furthermore, those devices can (and have been) the subject of inspections by local water utility companies. It is important for you as a Connecticut dentist to understand what is required prior to being inspected.

What is a backflow prevention device? Quite simply, a backflow prevention device is used to use to prevent back-siphon age of contaminated fluids into the public water supply.

What specifically does Connecticut require? The CT DPH Fact Sheet on Backflow Prevention at Dental offices (link below) provides information on State requirements. However, it is important to note that a local water utility always has the option of having policies that are more stringent than the State's requirements.

How can I find out what's required in my area? If you are unsure about the backflow prevention device requirements in your area, please contact your local water utility company. The links to some of the larger water utilities in the State are listed below.

Useful references:

Dental Assistants Regulations & Requirements

DANB Infection Control Examination

In 2019, the Legislature passed a bill that requires all Connecticut dental assistants to pass the Dental Assistant National

Board’s (DANB) Infection Control Examination (ICE) or an infection control competency assessment administered by an institution accredited by the American Dental Association’s Commission on Dental Accreditation.  Dental Assistants must successfully complete the DANB ICE or a competency assessment exam by October 1, 2020.* All dental assistants must provide records demonstrating successful completion of the DANB ICE or the infection control competency assessment.

* New Connecticut dental assistants hired after July 1, 2019 have fifteen months from the start of employment to receive on-the-job training by a licensed dentist to prepare for and pass the exam or assessment, if they have not done so already.

 

Continuing Education

Effective January 1, 2018, upon successful completion of the Dental Assisting National Board’s infection control examination or an infection control competency assessment, all dental assistants will be required to complete not less than one hour of training or education in infection control in a dental setting every two years.

Dental Hygiene Practice Act

Connecticut General Statues: Chapter 379a - Dental Hygienists

CT Department of Public Health
Dental Hygiene Practice Act

 

Dental Practice Act

Connecticut General Statutes: Chapter 379 - Dentistry

CT Department of Public Health
Dental Practice Act

Expanded Function Dental Assistants

During the 2016 Legislative Session, the Legislature passed Public Act 16-66 which established a new designation of dental assistants called expanded function dental assistants or EFDAs in Connecticut.

This law allows a dentist to delegate more procedures if the assistant becomes an EFDA. It also places a number of requirements on EFDAs and the dentists that hire them.

Connecticut Requirements to Earn EFDA Status:

  • Pass the DANB Certified Dental Assistant or Certified Orthodontic Assistant exam and maintain current certification
  • Successfully complete an EFDA education program at an institution of higher education that is accredited by the Commission on Dental Accreditation
  • Pass the DANB CPFDA exams (Coronal Polish, Sealants, Topical Anesthetic and Topical Fluoride)
  • Pass the DANB CRFDA exams (Anatomy, Morphology and Physiology; Impressions; Isolation; Sealants; Temporaries; and Restorative Functions)
  • A dental assistant must meet all the state requirements to earn EFDA status.

The State of Connecticut does not issue a state certificate or certification to dental assistants who have met all EFDA requirements. It is the supervising dentist’s responsibility, before delegating any EFDA functions to any dental assistant, to verify that the dental assistant has met ALL of the state’s EFDA requirements.

Infection Control in Dental Practice: COVID-19 Requirements

CT Department of Public Health developed a "Best Practices for Dental Offices Considering Expanding Operations Beyond Emergency Care to Include Non-Urgent and Elective Procedures During the COVID-19 Pandemic."

Download the CT Best Practices Document

Infection Control in Dental Practice and Regulatory Response

The Department of Public Health is authorized under Connecticut General Statutes, 19a-14(10)(11) to investigate complaints against health care practitioners. The Dental Practice Act which is defined in Chapter 379 of the Connecticut General Statutes allows the Department and the Board to seek disciplinary action under Section 20-114 for "incompetence or negligent conduct toward a patient".

How does the Department of Public Health Evaluate Infection Control Practices?
During the 2016 session, the Legislature passed a bill which mandated dental offices to adhere to the most recent version of the CDC’s guidelines for infection control in dental settings. The guidelines were updated in September 2016. Of particular interest is the addition of the sterilization of hand pieces in-between patients.

National Centers for Disease Control and Prevention Guidelines
Checklists from the "CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care":

Mercury Amalgam

Best management practices (BMP’s) replace the October 23, 2003 BMP’s for mercury amalgam and are intended to help dental practitioners comply with the requirements of Sections 22a-616(d) and 22a-622 of the Connecticut General Statutes (CGS) concerning the management of amalgam.

DEEP has also developed a Certification Form on which dental practitioners certify that their practice(s) or clinic(s) is in compliance with the state adopted BMPs.

Certificate Form

Amalgam Separator Inspection Form - Dentists in Connecticut, and now across the country, are required to perform inspections and keep records of such inspections for their amalgam separators. There is no prescribed form, you can make up their own, or you can use the sample form below one, or modify it if they choose. At some point in the future, the Department of Energy and Environmental Protection may randomly ask dental practices to submit inspection records as evidence of compliance with best management practices, specifically having and maintaining an amalgam separator. Please Note: This specific form doesn’t ensure compliance with all best management practices and you should become familiar with the DEEP standards.

In Connecticut, dentists are required to follow the best management practices for mercury amalgam. According to the law, every dental office must have an amalgam separator installed and well maintained. Following these best management practices will prevent mercury from being discharged into the wastewater where it can settle into the sludge. The department is exploring a program to conduct virtual inspections of dental offices for compliance with the amalgam separator requirements. The inspections would be scheduled allowing the dental offices to prepare and facilitate the inspection process. The inspections would be conducted using a phone or tablet and designed to last 10 minutes or less. The department would appreciate your feedback to determine the best way to conduct an inspection.

Link to the survey is below:
https://www.surveymonkey.com/r/CX38LN8

Additional information:
https://portal.ct.gov/DEEP/P2/Mercury/Dental/Best-Management-Practices-for-Mercury-Amalgam

https://portal.ct.gov/DEEP/P2/Mercury/Mercury-Information

Mobile Dental Providers

In response to questions regarding the credentials of mobile dental programs offering to provide oral health services to children in school settings, the CSDA and the Department of Public Health have reissued a letter to school administrators highlighting questions to be asked in order to assess the appropriateness of protocols in place by the mobile dental program. Review the letter sent to school superintendents, principles and school nurses in Connecticut.

Read the Mobile Dental Provider Letter

New Paid Family Leave Payroll Deduction

During the 2019 legislative session, the Legislature passed a bill that expanded Connecticut’s Paid Family and Medical Leave Act (PFMLA). Beginning on January 1, 2021, every employer with one or more employees must participate in the plan by collecting 0.5% of each employee’s wages and remit them as a contribution to the Connecticut Paid Leave Authority Trust Fund. Connecticut employees won’t be able to access the fund until January 1, 2022.

For further information and resources about Connecticut’s PFMLA, please visit CT Paid Leave Authority’s website. In addition, you can check out Connecticut Paid Leave Frequently Asked Questions Video.

Non-Covered Services

In 2011, the Connecticut General Assembly passed a non-covered services legislation that prohibits most insurance providers from dictating the rates that dentists can charge to their patients for any services or procedures that are not covered under their dental plans. While self-funded and collectively bargained (i.e. union) insurance plans were not covered under this new law, it does apply to all other dental provider contracts that are signed, renewed or amended after January 1, 2012.

The law also requires that dentists post a notice in their office to inform patients that not all dental services may be covered under their insurance plans. Click on the links below to access and print the notice for your practice.

Opioid Prevention

Public Act 18-166 prohibits prescribing practitioners from prescribing, dispensing or administering schedule II to IV controlled substances to themselves or immediate family members.  An immediate family member is defined as a spouse; parent; child; sibling; parent-in-law; son or daughter-in-law; brother or sister-in-law; step-parent, child or sibling; or other relative residing with the prescriber.

In an emergency, the bill allows prescribers to prescribe, dispense, or administer up to a 72-hour supply of a schedule II to IV controlled substance to themselves or immediate family members, but only if there is no other qualified prescriber available. If prescribing, dispensing or administering to a family member, the prescriber must (1) perform an assessment for the patient’s care and treatment; (2) medically evaluate the patient’s need for the controlled substance; and (3) document the emergency, assessment and patient’s need in the normal course of his or her business. (Effective as of July 1, 2018)

Public Act 17-131 requires various changes to prevent and treat opioid drug abuse.  Several of these items can impact dental practices that write prescriptions for opioids, including:

  • Requires prescribing practitioners to electronically transmit the controlled substance prescription to a pharmacy (effective January 1, 2018);
    • To apply for a waiver, a provider must contact the CT Department of Consumer Protection Drug Control Division directly. They can be reached at (860) 713-6065 or DCP.DrugControl@ct.gov
  • Requires practitioners, when prescribing opioids, to discuss with all patients, rather than only minors, the risks associated with opioid drug use;
  • Anyone who does not wish to be issued a prescription for an opioid drug may file a “voluntary non-opioid directive”   form with a prescribing practitioner. Upon reviewing the form, the prescribing practitioner must document it in the patient’s medical record;
  • A prescribing practitioner shall not issue a prescription of an opioid drug to a minor for more than a five-day supply of such drug; and
  • By October 1, 2017, the Alcohol and Drug Policy Council (ADPC) is required to develop a one-page fact sheet on opioid drugs. The ADPC must make the fact sheet available on the Department of Mental Health and Addiction Services website. Health care providers are encouraged to disseminate the fact sheet to anyone they provide an opioid drug prescription to.
  • Department of Mental Health and Addiction Services - Opioid Fact Sheet

During the November 2017 CSDA Continuing Education Course, Rodrick Marriott, Director of the Drug Control Division of the State of CT Department of Consumer Protection, spoke to Connecticut Dentists. During the talk Mr. Marriott clarified the new opioid legislation that recently passed, including the new regulation that requires prescribing practitioners to electronically transmit controlled substance prescriptions to a pharmacy (effective January 1, 2018). The video is below for your reference:

Patient Access to Medical Records

Frequently Asked Questions on Patient Access to Medical Records according to the provisions of the Connecticut General Statutes.

Learn More About Dental Records

Permit to Administer Dental Anesthesia and Conscious Sedation

Connecticut Department of Public Health guidelines for obtaining dental anesthesia and conscious sedation permit.

Read the Guidelines

Prescription Monitoring Program

The prescription monitoring program collects prescription data for Schedule II through Schedule V drugs into a central database, the Connecticut Prescription Monitoring and Reporting System (CPMRS), which can then be used by providers and pharmacists in the active treatment of their patients.

Sexual Harassment Training

Notice: Pursuant to Executive Order 7DDD, as amended by Executive Order 10A, the Oct. 1st Sexual Harassment Prevention Training deadline has been extended to April 19, 2021 due to the Covid-19 Pandemic. This is a blanket extension and does not require a request to be made. If there are any questions, please contact CHRO.Questions@ct.gov.

A new law went into effect on October 1, 2019 that establishes new rules and requirements regarding sexual harassment training and education. Employers with three or more employees will now have to:

  • Provide all existing employees with two hours of training by October 1, 2020 January 1, 2021
  • Provide to a new employee a copy of information regarding the illegality of sexual harassment and remedies available to victims
  • Provide two hours of training and education to new employees hired on or after October 1, 2019 within six months of their start date
  • Provide periodic supplemental training not less than every ten years

Employers with fewer than three employees must provide two hours of training and education to all existing supervisory employees by October 1, 2020 January 1, 2021 or within six months to new supervisory employees.

The Commission on Human Rights and Opportunities has developed a free online training and education video. View the Commission on Human Rights and Opportunities for further information regarding these new regulations and the training video.

Single-Use Plastic Bag Fee

Effective August 1, 2019, retailers making sales in Connecticut of tangible personal property to the public are required to collect a 10 cent fee per single-use plastic checkout bag. "Single-use checkout bag" is defined as a plastic bag with a thickness of less than four mils and is provided by a store to a customer at the point of sale. "Store" is defined as any retailer, as defined in Conn.Gen.Stat 12-407, that maintains a retail store within the state and sells tangible personal property directly to the public. This definition includes any dental office with a sales tax permit.

For example, if a dental office is using a plastic bag to provide their patients with promotional materials or free items, such as a toothbrush and or floss, then the dental office is not required to collect a fee. If, however, a dental office has a sales tax permit and is selling items to their patients, such as an electronic toothbrush and uses a plastic bag with a thickness of less than four mils, to provide the product to the patient, then the dental office is required to collect a 10 cent fee and report that to the State.

For further information, refer to the CT Department of Revenue Services Guidance Sheet Regarding the Single-Use Plastic Bag Fee.

If you have additional questions regarding the plastic bag fee, please contact the CT Department of Revenue Services (DRS) directly. You can email DRS Legal Division at legal.division@po.state.ct.us or call DRS at (800) 382-9463.

State Inspections of Dental Facilities and X-ray Machines

The CT Department of Energy and Environmental Protection (DEEP) has shared this information regarding their state inspection process of dental x-ray operations. The information is provided in hopes that the DEEP, in tandem with the CSDA, can enhance mutual effectiveness, communicate regulatory requirements, and maintain low dose and high quality dental imaging. If you have any additional questions, please feel free to contact the CT DEEP Radiation Division at 860.424.3029.

Virtual Credit Cards Payments

Specified health insurance carriers that issue policies covering inpatient or outpatient dental services are required, at least once during the term of a contract, to permit a licensed dentist who provides covered dental services to an insured to refuse to accept reimbursement for such services by way of virtual credit card. Such refusal shall apply to all covered dental services provided by such dentist during the term of such contract. “Virtual credit card” means a single-use credit card exclusively provided in an electronic or digital format.

Effective Date: January 1, 2019

Water Fluoridation in Connecticut

Fluoridation became a law in Connecticut on May 18, 1965, initiated by Public Act 156. Public Water Systems (PWSs) serving 50,000 or more were required to begin fluoridation on January 1, 1967, and PWSs serving 20,000 to 49,999 people were required to begin fluoridation on October 1, 1967. The amount of fluoride in many drinking water supplies is changed to a level to help reduce tooth decay and promote good oral health. Research studies have shown that water fluoridation is safe, effective and the best way to improve oral health in a community.

ADA Applauds USPHS Final Recommendations

Various CT Water Utility Companies (yours may not be listed):

October 1, 2021 Laws Went Into Effect

On October 1, several new bills that were signed into law went into effect and may have an impact on how you do business as a small business owner. Also, included are new employment laws that went into effect in 2021.

Gender Wage Discrimination

The statute, which also extends the prohibition on gender-based wage discrimination, imposes new disclosure requirements for both job applicants and existing employees. Public Act 21-30 mandates that an employer disclose the salary range for an open position to a job applicant either at the applicant's request or before or at the time they are offered the position.

Read More

New Workplace Smoking Restrictions

A new smoking ban in Connecticut that goes into effect that will impact businesses large and small. The smoking ban, known as the Clean Air Act, is included in the state’s marijuana law. Under a provision of Public Act No. 21-1, employers can no longer provide smoking rooms and outdoor smoking areas must be at least 25 feet away from the building. This includes smoking cigarettes, cigars, and vaping.

Read More

Workers' Compensation

Connecticut law has for many years protected workers who assert their rights under the Connecticut Workers’ Compensation Act from being discharged or discriminated against by their employer.

Connecticut recently expanded this law to also prohibit employers from disciplining, deliberately misinforming, or deliberately dissuading an employee from filing a claim for workers' compensation benefits or a claim for payment of benefits from the Connecticut Essential Workers COVID-19 Assistance Fund.

COVID-19 Rehiring

A new Connecticut law requires certain employers who are looking to hire employees to initially recall employees who were laid off during the COVID-19 pandemic.

This law applies to hotels, lodging houses, food service contractors, and building service enterprises with 15 or more employees.

The law includes a detailed recall process and generally requires employees to be recalled in order of seniority.

Time Off to Vote

Employers must provide each employee two hours of unpaid time off to vote in any state election or special election for U.S. senator, representative in Congress, state senator, or state representative.

To be eligible, the employee must request the time at least two working days in advance of the election. This law is currently in effect.

Minimum Wage Increase

Effective August 1, 2021, Connecticut’s minimum wage increased from $12 per hour to $13 per hour.

The minimum wage will increase to $14 per hour on July 1, 2022 and to $15 per hour on June 1, 2023.

Beginning January 1, 2024, the minimum wage will be published in the employment cost index, which is computed by the U.S. Department of Labor, and for the first time in Connecticut, the rate will rise in accordance with economic indicators.

Age Inquiries in Employment Applications

Effective Oct. 1, 2021, employers are prohibited from requesting or requiring a prospective employee to provide their age, date of birth, dates of attendance at or graduation from an educational institution on an initial employment application, unless age is a bona fide occupational qualification or such information is required to comply with any provision of state or federal law.

Discrimination Based on Natural Hair

Connecticut recently passed the CROWN Act, which stands for Create a Respectful and Open World for Natural Hair.

This law, effective March 4, 2021, prohibits discrimination on the basis of traits historically associated with race including, but not limited to, hair texture, and protective hairstyles.

Protective hairstyles includes, but is not limited to, wigs, headwraps and hairstyles such as individual braids, cornrows, locs, twists, Bantu knots, afros, and afro puffs.

Read Carmody’s previous blog on What Employers Need to Know About Connecticut’s New Anti-Discrimination Law, the CROWN Act for more details.

Employee Demographic Reporting

Employers must, as of the dates noted below, begin reporting employee demographic data with their quarterly unemployment reports.

The demographic data must include each employee’s gender identity, age, race, ethnicity, veteran status, disability status, highest education completed, home address, address of primary work site, occupational code, hours worked, days worked, salary or hourly wage, employment start date in the current job title, and, if applicable, employment end date.

Employers with 100 or more employees must start reporting in the third calendar quarter of 2024; employers with 99 or fewer employees must start reporting in the third calendar quarter of 2026; and employers with 49 or fewer employees without an electronic payroll system must start reporting in the third calendar quarter of 2028.

Education Assistance Programs

Employers with 100 or more employees must notify their Connecticut resident employees if the employer offers an education assistance program.

If the employer does offer such a benefit, the employer must provide details of the plan and how employees may apply for such benefits.

Federal Regulations

Americans with Disabilities Act

The Americans with Disabilities Act of 1990 is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability. This link will take you to the American Dental Association's Americans with Disabilities Act Q&A. It is important to note that ALL practicing dentists are affected by this law, since dental offices are considered public accommodations under the Act.

Access the JADA Q&A

Electronic Health Records

An electronic health record (EHR) is a digital version of a paper chart that contains all of a patient’s medical history from one practice. An EHR is mostly used by providers for diagnosis and treatment.

Electronic Health Records

HIPPA

The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; the HIPAA Breach Notification Rule, which requires covered entities and business associates to provide notification following a breach of unsecured protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.

Infection Control for Dentistry: OSHA/CDC COVID-19 Requirements

OSHA: Dentistry Workers and Employers

This guidance is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards.

Learn More About OSHA COVID-19 Guidelines

 

CDC: Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response

Learn More About CDC COVID-19 Response

Infection Control Practices for Dentistry

Developed by CDC staff in collaboration with a working group of infection control experts, the document contains a review of the scientific evidence regarding dental infection control issues as well as consensus, evidence-based recommendations.

Checklists from the "CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care":

For State of Connecticut Infection Control in a Dental Practice Regulations, look under State Regulations, above.

OSHA Guide for Medical & Dental Offices

State plans establish guidelines and standards to promote worker safety and health that apply to every workplace in the United States, including medical and dental offices. A glimpse of the most frequently found hazards in medical and dental offices.

Section 1557 of the Patient Protection and Affordable Care Act

The Office for Civil Rights has issued a final rule that prohibits health care entities that receive certain federal financial assistance, including Medicaid and CHIP, from discriminating based on race, color, national origin, sex, age or disability. According to ADA’s Health Policy Institute, 42% of dentists across the country were enrolled in Medicaid programs in 2014, and will therefore be subject to this rule.

The rule, went into effect July 18, 2016 and implements Section 1557 of the Affordable Care Act, required the affected parties by October 16, 2016 to post taglines in multiple languages and nondiscrimination notices in their offices, on their websites and in significant publications and communications. The ADA provides a number of resources, including a checklist, Q&A and sample documents for dental practices, free of charge only to ADA members to help them comply with this rule at success.ada.org. Read more in ADA News.

Hundreds of ADA members attended the webinar Understanding Section 1557 and it is now available for all members to view.

DEA Registration Requirement Effective June 27th

In December 2022, the U.S. Congress passed an omnibus spending bill that included the Medication Access and Training Expansion (MATE) Act. This new law requires prescribers of controlled substances, including dentists, to complete eight hours of one-time training on safely prescribing controlled substances (Schedules II, III, IV, and/or V) in order to receive or renew their registration with the U.S. Drug Enforcement Administration (DEA).

It’s likely that you received an email from the DEA last week notifying you of this new requirement, which goes into effect on June 27, 2023.

To help dentists comply, the ADA has created a Frequently Asked Questions document addressing common questions we have heard from members, including:

  • Does this new federal training requirement affect me?
  • What am I required to do?
  • How much time do I have to satisfy the new training requirement?
  • Do I need to maintain records showing I have completed the training?
  • How will I know what courses will satisfy the requirement?
  • Will training hours completed prior to the law’s passage count toward the new requirement?
  • Will I have to complete the 8 hours of federally required CE on a cyclical basis?\
  • Will CE credits that are accepted for state licensure count toward the new federal requirement?
  • Can my state impose additional CE requirements?
  • Am I required to complete training on topics that are outside of my scope of practice?
  • Do I have to use a specific CE provider? Will ADA CERP credits count?
  • Does the ADA offer CE on safe controlled substance prescribing?

The ADA will update the FAQ regularly to answer new questions and share additional information. Currently, our team is working to address questions about how the DEA will enforce the requirement, how the rule will affect prescribers with multiple DEA registrations, and other topics.

If you have further questions, the ADA’s Member Service Center is here to help. Contact the MSC via e-mail at msc@ada.org or call 312-440-2500. Staff are available Monday through Friday from 8 a.m. - 5 p.m. central time.