On June 25, 2021, the N.C. State Board of Dental Examiners (“the Dental Board”) sent out correspondence to its licensees on some important Legislative updates. In addition to being a member of the N.C. State Bar, I am also a N.C. Registered Dental Hygienist (“RDH”) who received this correspondence. The Dental Board has been hard at work over this past year and here is a break-down on important information for N.C. Dentists and Dental Hygienists.
STOP Act Requirement to Search the CSRS Before Prescribing Starts July 7, 2021
Although the NC General Assembly passed the Strengthen Opioid Misuse Prevention Act (“STOP Act”) in 2017, certain portions were scheduled to go into effect at later dates. The passage of the STOP Act was an important step in addressing the nationwide opioid epidemic and its substantial impact on North Carolina.
Beginning July 7, 2021 North Carolina Dentists must search the NC Controlled Substances Reporting System (“CSRS”) before prescribing targeted controlled substances. A targeted controlled substance means any Schedule II or Schedule III controlled substance as defined by N.C. Gen. Stat. § 90-91 (1) or (2) or N.C. Gen. Stat. § 90-91(d). The CSRS collects and makes information available on dispensed controlled substance prescriptions. In addition to searching the CSRS before issuing a new targeted controlled substance prescription, the CSRS report must be reviewed by the prescriber every three months that the medication is prescribed. Should the prescriber change the dose of the patient’s current medication or change the medication to a different targeted controlled substance then the CSRS must be searched just as if a brand new prescription is being issued. The CSRS query must be noted in the patient’s chart.
The purpose of the prescriber’s CSRS search is to assist clinicians in identifying patients misusing controlled substances and to potentially refer those patients for treatment. Importantly, the search requirement aims to reduce unintentional drug overdose.
The STOP Act requires The North Carolina Department of Health and Human Services (“NC DHHS”) to conduct periodic audits of the prescriber’s review of the CSRS prior to prescribing a targeted controlled substance. Further, NC DHHS must report any violation of the CSRS search requirement to the appropriate licensing board. A violation of the CSRS requirement may give cause for the licensing board to suspend or revoke a prescriber’s license. Therefore, the licensing board (here the Dental Board), not NC DHHS, holds the authority to enforce the CSRS search requirement.
Dentists that use electronic health records (“EHR”), can integrate the CSRS into their EHR system. The information on the technical process of integration can be found at this link. Additionally, NC DHHS received a grant that offers 1:1 technical assistance to prescribers, dispensers, researchers, and the public health community on how to access the CSRS system which is scheduled to last until September 2022. Information on requesting technical assistance can be found at the NC DHSS: CSRS Mandatory Use and Technical Assistance page.
House Bill 144 on Teledentistry and RDH Administration of Local Anesthetic
North Carolina has been one of the last states to consider legislation allowing a Registered Dental Hygienist to administer local anesthetic to a patient. At last, it appears there is finally a Bill chugging through the N.C. Legislative process. House Bill 144 (“HB 144”) has now passed the House and its first reading in the Senate. For those interested in following its progress through the legislative process, the North Carolina General Assembly House Bill 144 webpage provides updates and contains a copy of the current version of the Bill that is under consideration.
HB 144 proposes to allow N.C. licensed dental hygienists to administer local anesthetics by infiltration and block techniques while under the direct supervision of a licensed dentist. For the purposes of this provision, direct supervision must be accomplished by the supervising licensed dentist being physically present in the location where the RDH is administering the anesthetic. HB 144 also sets out educational requirements for the RDH to be qualified in the administration of local anesthetics. The proposed Bill includes a reciprocity provision for RDH’s that have already met certain educational requirements and who have been lawfully administering local anesthetics in another jurisdiction before relocating to North Carolina.
Even more exciting is HB 144 seeks to establish standards for the proper use of teledentistry. Over the years, North Carolina has been reluctant to relax its requirements for direct in-person dental care and direct in-person supervision of dental hygienists. This Bill represents a move towards teledentistry becoming a more utilized tool to increase access to dental care by redefining supervision as it relates to the proposed teledentistry standards. HB 144 provides that the practice of teledentistry would include both a N.C. licensed dentist and a N.C. licensed dental hygienist who is under the supervision of a N.C. licensed dentist. Thus, dentists or dental hygienists that may be licensed in other jurisdictions but are not licensed in North Carolina would not be able to lawfully participate in delivering teledentistry services in N.C.
The supervision requirement that is contained in the teledentistry provisions of HB 144 would be satisfied if the acts are performed pursuant to a licensed dentist’s order, control, and approval and does not require the physical presence of the licensed dentist. These are big changes for North Carolina dentists and dental hygienists who have been subject to direct physical presence provisions for many years. The information in this article is only skimming the surface of the proposed teledentistry standards and more in-depth exploration will be warranted should HB 144 be enacted into law.
In the Dental Board’s correspondence, it commended those who worked to make HB 144 possible and assured its licensees that the Dental board stands ready to draft rules in support of the legislation should it become law. This legislation represents an exciting opportunity for North Carolina dentists and dental hygienists to be able to provide North Carolinians with greater access to necessary dental care.