MA State Laws For Dental Professionals

Scrap amalgam and amalgam separator cartridges, elemental mercury, fluorescent light bulbs, and any waste containing amalgam or mercury should be recycled through an amalgam recycler.

General dentists, pediatric dentists, endodontists, and prosthodontists are required to install an amalgam separator in their offices and certify with the Massachusetts Department of Environmental Protection (MassDEP) that the office is in compliance with this regulation. Oral surgeons, periodontists, and orthodontists do not need to install a separator at this time. After initial certifications are filed with the MassDEP, renewal certifications are required every two years (by March 31 of every even-numbered year, which coincides with dental licensure).

Requires all dentists in Massachusetts to:

• Install mercury amalgam separators (if they install or remove mercury amalgam);
• Maintain their separators in accordance to manufacturer specifications; and
• Recycle the collected mercury amalgam.

Additional Resources:

• Best Practices for Handling and Recycling Amalgam and Mercury Waste
• MassDEP Dental Amalgam Website

Amalgam Registration Fee and Renewal

•  Renewal Cycle: The revised regulations changed the renewal cycle for certification from a five-year requirement to a two-year requirement. Certification forms will be due every two years on March 31 of even-numbered years. This coincides with your biennial dental license renewal to the Division of Health Professional Licensure. 
• Fee: The certification fee is $200 every two years (previously a five-year cycle).

These regulations apply to all Massachusetts dental practices and facilities that generate or discharge wastewater from mercury amalgam-related processes. The purpose of 310 CMR 73.00 is to protect public health, safety, welfare, and the environment. These regulations establish wastewater treatment, operational standards, and amalgam recycling requirements to reduce the amount of mercury discharged from dental facilities, and require a performance-based compliance certification from the owners of dental practices in compliance with 310 CMR 70.00.

MassDEP Dental Helpline 617.292.5647.

Environmental Protection Agency Final Rule

In December 2016, the EPA issued a final rule requiring most dental offices nationwide to install amalgam separators; however, it withdrew the rule following the White House’s memorandum ordering federal agencies to freeze all new or pending regulations. The rule became effective on July 14, 2017, and compliance for most dentists was due by July 14, 2020.

The rule mandates that most dental offices install, maintain, and monitor an amalgam separator that complies with the American National Standards Institute (ANSI) American National Standard/American Dental Association (ADA) specifications. You may continue to operate an already-installed amalgam separator for its lifetime or 10 years (whichever comes first) as long as you comply with the rule’s other requirements, including the specified best management practices, operation and maintenance, reporting, and record-keeping requirements. The compliance date for this rule for existing offices was December 31, 2019. Newly purchased or built offices must comply within 90 days of taking ownership.

If your dental office does not place or remove dental amalgam, you may be exempt from amalgam compliance regulations. In the final rule, dental offices that do not place dental amalgam and do not remove dental amalgam except in limited emergency or unplanned, unanticipated circumstances are exempt from any further requirements, provided they certify this in their One-time Compliance Report to their Control Authority. In this way, if, over time, the use of dental amalgam is phased out as a restorative material, the requirements of this rule will no longer apply. Under limited circumstances, the EPA refers to dental offices that remove amalgam at a frequency of less than 5% of their procedures.  On average, this percent approximates to 9 removals per office per year (DCN DA00467).

Record Keeping
Dental practices and facilities must maintain on-site records to demonstrate compliance with the Amalgam Regulations for Dental Facilities (310 CMR 73.00). Records must be kept for at least five years, as required by 310 CMR 73.06(2).

The Board of Registration in Dentistry (BORID) is the state agency responsible for governing the practice of dentistry. BORID grants licenses to practice, determines continuing education requirements for dentists, dental assistants, and dental hygienists, and investigates consumer complaints. All dentists in Massachusetts need to be familiar with the regulations in their entirety. 

The MDS encourages members to be especially diligent in reviewing the sections on anesthesia (234 CMR 6.00), continuing education (234 CMR 8.00), and the practice of dentistry (234 CMR 5.00).

Should you conduct a background or Criminal Offender Record Information Act (CORI) check on prospective employees? 

Dentists are not required under Massachusetts law to conduct CORI checks.  Certain employers that deal with vulnerable populations or are required to conduct checks (e.g., nursing homes, schools, daycare centers, and hospitals) are required to do so. However, even employers that are not required to perform CORI checks on prospective employees, such as dentists, may do so. 

The MDS Dental Practice Committee encourages members to consider incorporating CORI checks into their pre-employment screening process. Still, it is essential that any such checks are conducted in accordance with applicable laws and regulations.

The purpose of 105 CMR 480.000 is to set forth minimum requirements for the storage, treatment, disposal, and transportation of medical and biological waste. Dental offices need to be well-informed about the laws governing the management of medical and biological waste. The law requires the use of a logbook with secured, consecutively numbered pages, which shall be used solely for keeping and recording information.

According to the U.S. Centers for Disease Control and Prevention, medical waste is “waste sufficiently capable of causing infection during handling and disposal.” This may include blood-soaked bandages, discarded surgical gloves, and discarded sharps, among other items—all of which require special handling and disposal. Unfortunately, many people are injured each year from improper disposal of medical and biological waste.

Download this DPH-approved medical and biological waste record-keeping log as a valuable resource for effective practice.

Dentists are mandated reporters of abuse and neglect. However, it’s essential to note that, under Massachusetts law, mandated reporters are protected from liability in any civil or criminal action, as well as from any discriminatory or retaliatory action by an employer.

With many physical abuse cases resulting in injuries to the head, neck, and/or mouth, the dental community is in a fundamental position to be the first advocates for patients suffering from abuse and neglect. Studies conclusively state that health care professionals who acknowledge that abuse has occurred have a positive impact on their patients. The dental team’s role in combating abuse and neglect includes recognition and referral. By being observant and reporting suspected cases, you can help shield your patients, both young and old, from violence and neglect.

Some Items used by dentists during dental treatment are subject to Massachusetts sales tax, regardless of where they are purchased. If an item is subject to tax, the dentist must pay the sales tax to the Commonwealth even if the supplier is located out of state and has not charged a tax.

To comply with the state’s Paid Family and Medical Leave (PFML) regulations, all Massachusetts employers are required to do the following:

Posting Requirement

• Employers were required to display a poster describing PFML benefits in a highly visible location. The posting must be in English and also any other language that is the primary language of five or more employees.
• The Department of Family and Medical Leave has produced a poster for employers to utilize (the poster is available in multiple languages).

Written Notice Requirement

• Employers are required to provide written notice to their current workforce of PFML benefits, contribution rates, and other provisions as outlined in M.G.L. c. 175M sec. 4. Contribution rates and benefit amounts are updated annually. 

New Employee Requirement

• Employers must provide new employees with a notification form within 30 days of their hire date. 
• Employees are required to sign the form and return it to the employer.

The MDS also recommends you reach out to your payroll provider and/or accountant to discuss the required payroll deductions related to this regulation. Payroll deductions must be provided to staff.

For more information, please view these additional resources: 

• Notification Information
• Massachusetts Employer Information and Toolkit 
• Informing Your Workforce About PFML Information
• PFMLA Employer Contribution Rates and Calculator

On January 1, 2022, Governor Baker signed the “Patients First Act” into law. This act requires healthcare providers, including dental providers, to inform patients of the costs associated with planned procedures in advance of treatment, based on the patient’s specific dental insurance plan benefits. Starting July 31, 2022, the Department of Public Health may fine providers who fail to comply with the requirements with a penalty of up to $2,500 for each non-compliance.   

If you have not already done so, we encourage providers to implement the necessary procedures to meet the new notice and billing requirements, thereby minimizing the risk of regulatory scrutiny. Please note:

• If a dental provider is unable to quote a specific amount in advance of care due to an inability to predict the course of treatment, the provider must disclose a maximum allowed amount for the service.
• If the provider does not participate in the patient’s dental benefits plan, they must inform the patient at the time of booking that the patient will be responsible for the cost of service, or they must advise the patient that they can seek treatment with another provider who participates in the dental plan for a possible lower treatment cost.  
• The MDS recommends that providers keep a copy of all patient communication regarding this process in the patient’s record.

Note: The MDS is actively engaged in legislative action related to this law, which we believe was not intended to apply to dental professionals.

MassPAT

All prescribers are required to check the state’s prescription monitoring program, the Massachusetts Prescription Awareness Tool (MassPAT), each time they prescribe a Schedule II-III opioid and when prescribing a benzodiazepine or Department of Public Health-designated Schedule IV-VI drug for the first time. The massPAT shows a patient’s prescription history for the prior 12 months. Data is reported into MassPAT by all Massachusetts pharmacies and by out-of-state pharmacies delivering to people in Massachusetts. The MassPAT prescription history data informs clinical decision-making to help prevent or stop harm from duplicate drug therapy, prescription drug misuse, abuse, and diversion. This new system replaces the PMP Virtual system.

Prescription Regulations

These regulations include information based on federal and Massachusetts laws governing the writing of prescriptions, including written prescription requirements, prescription pad compliance, and other relevant topics.

As a dental practitioner, it is essential to familiarize yourself with the information outlined in the Massachusetts Radiation Control Regulations, which provide details on the general requirements for dental radiographic systems, X-ray controls, frequency requirements, and maintenance/calibration requirements for dental offices.

MA Radiation Control Regulations

Radiographs (X-rays) can help the dental practitioner evaluate and definitively diagnose many oral diseases and conditions. The Commonwealth of Massachusetts Department of Public Health Radiation Control Program regulates the use of X-rays in 105 CMR 120.400 Healing Arts (dentistry falls under the Healing Arts). Included in these requirements are the following:

• Calibrations and preventive maintenance on X-ray systems shall be conducted every three years. 
• Calibrations and preventive maintenance may be done by your supplier (e.g., Benco Dental, Patterson, Henry Schein, etc.). 
• There is no requirement to conduct a physics survey.
• Protective equipment (aprons and shields) shall be inspected annually for defects, such as holes, cracks, and tears, to ensure reliability and integrity. Documentation shall be maintained for a period of five years.

Is there a law regarding the frequency of X-rays?

The Massachusetts State Regulations for Protection of Personal Information require all businesses to draft, implement, and update a comprehensive Written Information Security Plan (WISP) to protect “personal information” that businesses may have about Massachusetts residents.

The regulations—201 CMR 17.00 Standards for the Protection of Personal Information of Residents of the Commonwealth—have broad coverage. They extend to any company or individual that “owns, licenses, or stores or maintains personal information.” There is no exception for small businesses, such as dental offices.

“Personal information” in the regulations is defined as a Massachusetts resident’s first and last name or first initial and last name together with his/her Social Security number, driver’s license or state-issued ID number, bank or other financial account number, or credit card number. PIN numbers, passwords, or biometric information are also included. The regulations apply to both paper and electronic records.

A dental office most certainly maintains “personal information” on employees. If you request a Social Security number, driver’s license, or other information noted above from patients, this regulation also governs your handling of their patient information.