N95 masks & PPE supplies
We want to share some options in response to the questions we received regarding PPE supplies.
The Department of State Health Services recently removed their restrictions on who could obtain PPE from the state. Now when a health care provider cannot obtain PPE from their vendors and has exhausted all options to obtain PPE and supplies are nearing depletion, the health care provider may submit a request to the state through a State of Texas Assistance Request (STAR) by working with their local emergency management office or disaster district coordinator. Contact your Texas District Coordinator to find out who your local emergency management representative is.
Please note that requests will be filled based on availability of supplies and are not guaranteed.
We were informed today that TDA members are eligible to order one box of 50 N95 respirators while supplies last. TDA members may begin ordering immediately. There will be a nominal fee of $40 for shipping and handling, plus credit card processing fees. Non-member dentists may begin ordering at 3:00 p.m. on Friday, May 29, 2020.
Please visit https://www.summitppe.com/ to place your order.
We will pass along any additional information we receive on PPE supplies.
TAPD Executive Board
TAPD Statement on Emergency Rule 22 TAC §108.7 (16)
Today, the Texas State Board of Dental Examiners (TSBDE) passed Emergency Rule 22 TAC §108.7 (16), which governs the reopening of dental practices in Texas. While this rule must go back to the governor for final approval, no changes are expected. We will post the official guidance to our social media and website when it posted in the Texas Register.
Dentists should use 22 TAC §108.7 (16) as official guidance for your practices during COVID-19. TSBDE advises you should not reopen your practice until you have the proper personal protection equipment (PPE).
For additional guidance and recommendations, please utilize AAPD’s re-emergence checklist.
TAPD thanks each of you for your feedback regarding reopening practices. Your recommendations were part of our correspondence with the TSBDE and the Governor’s Office. While you may begin practicing tomorrow, we hope you will do so in safe and prudent manner.
Member Update 4.27.20
I hope you and your families and friends are well. As you have likely heard, Gov. Abbott announced the timeline for reopening dental practices today via Executive Order 19, which loosens restriction on health care professionals, including dentists. Dentists are permitted to re-open their practices on May 1, but must follow safety standards set out by the Texas State Board of Dental Examiners (TSBDE). We expect TSBDE to promulgate emergency rules dictating these minimum standards ASAP.
Last week, the Governor’s Strike Force to Reopen Texas contacted TAPD seeking recommendations concerning the timing and appropriateness of returning to practice. TAPD submitted a “best practice plan” for a safe reopening of dentistry. We have sent this plan to TSBDE as well.
In addition to this, I’d like to share some of the issues TAPD has actively addressed during the Covid-19 pandemic. As soon as the impact of this crisis on our patients, families and practices became clear, TAPD began working with the various agencies, boards, dental schools and the Governor’s Office to help facilitate a safe and reasonable policy for providing dental care to our population. The initial response was to establish parameters for treating emergencies and ensure the various regulators understood the need to provide truly emergent care. Both TSBDE and the Governor’s Office clearly stated that we should continue to provide emergent care.
Additionally, we sent a letter to TSBDE requesting an extension of CE, PALS and CPR requirements. TSBDE extended license expiration dates by three months for dentists, hygienists and dental assistants who were due for renewal in March, April and May of 2020.
TAPD also contacted MCNA, Dentaquest and TMHP to advocate for retrospective reviews of claims when we begin opening our practices to expedite procedures and avoid further delaying care. This process is ongoing and we will update you when we have more information to share. We will also be asking the MCOs to raise our reimbursement fees to cover extra expenses associated with PPE.
TAPD has been hard at work with literally hundreds of hours of meetings and communications with medical and dental specialists and our elected officials. The critical feedback we received from many of you has been instrumental in this process. I understand we are all eager to get back to work. Currently, our virtual TAPD General Assembly meeting is scheduled for Friday, May 15 at 1:00pm. Because the practice of dentistry will again be open at that time, we will adjust the scheduled meeting to accommodate the return to work. We will send out a new date and time very soon. It is more critical now than ever for us to have robust participation in our annual meeting.
This has been a difficult time for us all, but please know that our primary concern continues to be your safety, as well as that of your staff and patients. We know the pandemic is far from over and we will face obstacles moving forward. We are committed to continuing to advocate the best possible care for Texas children and for all of you.
Refugio Gonzalez III, DDS
President, Texas Academy of Pediatric Dentistry
Texas State Board of Dental Examiners Statement
Today, the Texas State Board of Dental Examiners (TSBDE) issued the following statement regarding the Governor’s Executive Order 15:
Executive Order GA-15 addresses both licensed health care professionals and licensed health care facilities. The first statement in the order applies to both professionals and facilities, but the exceptions apply only to facilities. Therefore, licensed dental professionals are required to postpone procedures that are not medically necessary to diagnose or correct a serious medical condition of, or to preserve the life of, a patient who without timely performance of the procedure would be at risk for serious medical consequences or death, as determined by the patient’s dentist. This means that a dental professional may perform procedures that are medically necessary as clarified in the first statement of the order. In addition, dental professionals are directed to follow CDC guidelines when performing those procedures and are directed to follow state and local orders related to social distancing.
Governor Abbott’s Executive Order 15 is in effect until 11:59 p.m. on May 8, 2020, unless it is modified, amended, rescinded, or superseded by the governor. Until the order’s expiration, a dentist is limited to performing procedures that are medically necessary to diagnose or correct a serious medical condition of, or to preserve the life of, a patient who without timely performance of the procedure would be at risk for serious medical consequences or death, as determined by the patient’s dentist.
To find more guidance on this topic, please review the TSBDE’s FAQ: http://tsbde.texas.gov/
TAPD General Assembly Meeting and Proposed Bylaws Changes
I hope this email finds you and your families well and staying safe. We have identified an alternative option to hold our General Assembly meeting next month, since we will not be meeting in person.
We will host our General Assembly meeting virtually via Zoom on Friday, May 15 from 1:00 pm – 5:00 pm.
I encourage all members to attend. Below is the meeting agenda and proposed bylaw changes that we will discuss.
We will send a link in the coming weeks with instructions to access the meeting. If you have any questions or concerns prior to the meeting, please feel free to email me.
Looking forward to seeing as many of you as possible next month.
Refugio Gonzalez III, DDS
President, Texas Academy of Pediatric Dentistry
Guidance for TAPD Members on Latest Practice Restrictions
Gov. Greg Abbott has issued an executive order requiring all medical providers—including dentists—to delay until midnight on April 21 “all surgeries and procedures that are not immediately medically necessary to preserve a patient’s life or avoid adverse medical consequences.” In accordance with this executive order and to alleviate the burden on hospital systems, the Texas State Board of Dental Examiners issued a directive saying “…It is imperative that dental clinicians care for emergency patients in a timely manner rather than referring them to emergency facilities.” Violating the governor’s order is punishable by a fine or jail time.
It is up to each dentist’s professional judgment to determine what constitutes a medically necessary situation (ie, dental emergency), and you are encouraged to consult The American Dental Association (ADA) Emergency Procedures Guide as a reference. If you have any questions regarding this order, the standard of care or a specific case, please contact the Texas State Board of Dental Examiners at email@example.com.
Everyone in the medical/dental community is working hard—and working together—to respond to this unprecedented crisis. TAPD Secretary Ben Morgan is collecting information regarding donations of medical supplies and personal protection equipment (PPE) in conjunction with the Texas Hospital Association. If you have any medical supplies or personal protection equipment you would like to donate to hospital workers, please email firstname.lastname@example.org with your name, location and what supplies you have.
We know this is a difficult time for everyone and we hope this guidance helps answer the questions many of you have had. We are all in this together—please know that we are here to support you however we can. We will get through this together.
Dental Board Statement Regarding Gov. Abbott Executive Order
The following was issued by the Texas State Board of Dental Examiners:
In his press conference today, Governor Abbott issued an executive order restricting healthcare professionals and facilities. According to the Executive Order No. GA-09, “beginning now and continuing until 11:59 p.m. on April 21, 2020, all licensed health care professionals and all licensed health care facilities shall postpone all surgeries and procedures that are not immediately medically necessary to correct a serious medical condition of, or to preserve the life of, a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician;”
“PROVIDED, however, that this prohibition shall not apply to any procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the personal protective equipment needed to cope with the COVID- 19 disaster.”
Since the Governor is addressing a shortage of hospital capacity, it is imperative that dental clinicians care for emergency patients in a timely manner rather than referring them to emergency facilities. The governor also pointed out in his comments that violation of executive orders could lead to potential fines and even jail time for those who do not comply.
We are in unprecedented times and as much as we want concrete answers, COVID-19 is a fluid situation. TAPD continues to follow guidance from AAPD, ADA, TDA, the Texas State Board of Dental Examiners, the Governor’s Office and state and local public health authorities related to the latest information on COVID-19.
Below is the latest guidance from AAPD:
The ADA has recommended that dentists postpone elective procedures for the next three weeks. A number of states have strongly recommended that dentists postpone non-emergency care as well. These ADA and state recommendations are consistent with AAPD’s statement of March 16. Children in need of urgent/emergency care should be treated, while elective care can be postponed. Urgent/emergency care means treatment of pain, swelling, trauma, and infection. Hygiene and prophylaxis visits, cosmetic, and elective operative procedures should be considered non-urgent/non-emergency.
Governor Greg Abbott announced yesterday that he believes by the end of this week, everyone who needs a coronavirus test should be able to obtain one with a doctor’s order. TAPD encourages all of our members to visit the Texas Department of State Health Services and the Texas State Board of Dental Examiners websites to obtain the most up-to-date information for the state of Texas. They have a dedicated call center to answer COVID-19 related questions and concerns Monday-Friday 7:00am-6:00pm which can be reached at 1-877-570-9779.
We understand this is an anxious time for everyone. Your health and safety, and that of your patients, staff and families, is our highest priority. Our ongoing commitment to you is to ensure that you have the latest resources available to make an informed decision about your practices, and to continue to support you however we can. We are in this together.
Center for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/index.html
American Academy of Pediatric Dentistry https://www.aapd.org/about/about-aapd/news-room/covid-19/
American Dental Association https://success.ada.org/en/practice-management/patients/~/~/link.aspx?_id=6C881EF4A7884989A80BA475F9A116ED&_z=z
Texas Dental Association https://www.tda.org/
Texas Department of State Health Services https://www.dshs.state.tx.us/coronavirus/
Texas Department of State Health Services Statewide Cases https://www.dshs.state.tx.us/news/updates.shtm#coronavirus
Texas State Board of Dental Examiners http://tsbde.texas.gov/
I hope you, your families and staff are all well. The TAPD board understands and respects your concerns regarding Coronavirus (COVID-19) and want you to know we are speaking with and getting information from ADA, AAPD, TDA, CDC, the Governor’s Office and health authorities and will disseminate that information as quickly as possible to you. Know that we will not only support their recommendations, but we will assist them in any way possible.
Please be aware that the Texas Attorney General has issued a statement regarding price gouging of supplies. If any of you have any issues with increased prices of masks, hand sanitizer, gloves or other necessary items, please contact the Texas Attorney General’s toll-free complaint line at (800) 621-0508 or file a complaint online at www.texasattorneygeneral.gov/consumer-protection.
For information on the spread or treatment of Coronavirus (COVID-19), please visit the Texas Department of State Health Services at https://dshs.texas.gov/coronavirus/ .
Please do not hesitate to let us know if we can assist by emailing email@example.com.
Refugio Gonzalez III, DDS
President, Texas Academy of Pediatric Dentistry
Center for Medicare and Medicaid Services Letter
TAPD is committing to ensuring every Texas child has a change at optimal oral health. That is why we recently signed on to the following letter to the Center for Medicare and Medicaid Services (CMS) to highlight concerns for its recent guidance allowing states to apply for a waiver to set caps in their Medicaid programs.
Dear Administrator Verma:
As leading national, state, and local organizations, representing health care consumers and patients, providers, and other stakeholders, we are writing in strong opposition to recent guidance from CMS, Healthy Adult Opportunity, which allows states to fundamentally change the nature of their Medicaid programs. We urge the Administration to rescind this guidance, which could hurt millions of families that rely on Medicaid.
Medicaid is an essential source of coverage for over 70 million people. Medicaid’s current state-federal partnership helps states provide quality health insurance to their residents –it ensures that children are able to get a healthy start in life, provides long-term care to seniors and people with disabilities, and vital health care for many adults including pregnant women. The current state-federal funding structure provides states and taxpayers a level of financial security, ensuring that as Medicaid spending fluctuates from year to year, the state and its taxpayers are not made solely responsible for covering any increased costs. Efforts to restructure or cut Medicaid would shift health care costs to the states, hurt local economies, and threaten care and coverage for millions.
The Administration’s long-anticipated State Medicaid Director Letter, which was published on January 30, encourages states to adopt caps on their federal Medicaid funds voluntarily under a Medicaid section 1115 demonstration waiver. This arrangement involves major fiscal risk for states; the “flexibility” states will have is to cut services or take away coverage if and when they hit their new federal funding cap. Capping and restructuring Medicaid would create an awful choice for states in the event of increasing health care costs. Once that happens, the state will start rolling back coverage for kids, people with disabilities, and seniors and cost-effective optional benefits like dental care, without oversight.
Further, the Administration does not have jurisdiction to waive Medicaid’s financing structure through the 1115 waiver process. Such a fundamental change to Medicaid’s structure requires a change in statute and therefore an act of Congress. In 2017, when Congress considered federal funding caps, millions of people from around the country raised their voices in opposition, and lawmakers rejected the proposal on a bipartisan basis.
We urge the Administration to rescind this guidance that promises flexibility, but will surely lead to catastrophic implications for state budgets, and state Medicaid programs and the communities they serve. We implore you to reconsider this proposal, and protect the children, seniors, people with disabilities, women, parents, people of color, and working families that rely on Medicaid for health care.