OAR 333-028-0320: Local School Dental Sealant Programs: Certification Requirements

To be certified, a Local School Dental Sealant Program (SDSP) must meet all requirements for certification. During a declared state of emergency or public health emergency, the Oregon Health Authority, Public Health Division, Oral Health Program (Program) may, in writing, waive certification requirements. (1) To apply for certification, a Local SDSP must be an entity outside of the Program that has the infrastructure to operate a Local SDSP program that provides dental sealants in a school setting. If the Local SDSP applicant is a business entity, then it must be registered with the Oregon Secretary of State. (2) A Local SDSP must have a written policy to coordinate with schools, school districts, or public charter schools to facilitate background checks of Local SDSP staff as required by school policy as described in ORS 326.607. (3) A representative responsible for coordinating and implementing the Local SDSP must attend a one-time certification training provided by the Program prior to applying for certification. If the Local SDSP experiences personnel changes that impact the representative responsible for coordinating and implementing the Local SDSP, then a new representative must attend the one-time certification training before applying for recertification. (4) A Local SDSP must provide an annual clinical training to all of the Local SDSP’s providers rendering care within their scope of practice in a school setting. This requirement may be met by one of these methods: (a) A Local SDSP develops and implements its own training within the certification year. (b) A Local SDSP’s clinical providers attend an annual training provided by the Program. (5) When multiple Local SDSPs request to serve the same school, the Program will determine which Local SDSP will provide the services. The Program will consult with applicable Local SDSPs, Coordinated Care Organizations (CCOs) and schools involved. This collaboration will ensure access and minimize the duplication of services. The consultation will include topics such as, but not limited to: (a) Certification status of each Local SDSP; (b) Staffing capacity of each Local SDSP; (c) Capacity of each Local SDSP to serve additional grade levels or provide more oral health services; (d) Ability of each Local SDSP to provide students with referrals for further dental treatment; and (e) Existing relationships with schools. (6) A Local SDSP must ensure Medicaid encounters for dental sealants are entered into the Medicaid system. The Program shall provide Local SDSPs with a CCO contact list. (7) A Local SDSP shall first provide services at elementary and middle schools where: (a) Forty percent or greater of all students attending the school are eligible to receive assistance under the United States Department of Agriculture’s National School Lunch Program (NSLP); or (b) The school has been approved for the Community Eligibility Program (CEP); or (c) The school is located in a dental care health professional shortage area (HPSA). (8) A Local SDSP must offer, at a minimum, dental sealant services to all students regardless of insurance status or ability to pay as follows: (a) For elementary school, students in first and second grades or second and third grades. (b) For middle school, students in sixth and seventh grades or seventh and eighth grades. (9) Local SDSPs must comply with all applicable federal and state antidiscrimination laws and rules, including but not limited to Title IX of the Education Amendments of 1972, Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, and ORS chapter 659A. (10) A Local SDSP must adhere to these standards for school dental sealant programs: (a) Dental sealant services must be primarily provided on school grounds during normal course instruction hours; (b) A medical history is required on the parent/guardian permission form; (c) Use the four-handed technique to apply sealants in elementary schools. The second provider does not need to be a dental professional. Volunteers and non-dental professionals must receive training and adhere to infection prevention and control (IPC)protocols, equipment operation, confidentiality and security guidelines, all aspects of providing dental sealants in a school setting, and internal policies and procedures; (d) Use the two-handed technique using an Isolite or equivalent Program approved isolation device or the four-handed technique to apply sealants in middle and high schools when providing sealants; (e) Apply resin-based or glass ionomer sealants according to manufacturers’ instructions; and (f) Use compressor and suction capabilities at all times except in rare situations as determined by the provider’s professional judgment or as required during a declared state of emergency or public health emergency. (11) A Local SDSP must comply with all scope of practice laws as determined by the Oregon Board of Dentistry. (12) A Local SDSP must comply with Oregon Board of Dentistry oral health screening guidelines for screening and reporting results to parents/guardians. (13) A Local SDSP must comply with IPC protocols established in OAR 333-019-0061, OAR 818-012-0040, and by the Oregon Board of Dentistry, Oregon Occupational Safety and Health Administration (Oregon OSHA), and the U.S. Centers for Disease Control and Prevention (CDC). (14) A Local SDSP that is subject to the Health Insurance Portability and Accountability Act (HIPAA) or the Family Educational Rights and Privacy Act (FERPA) must comply with the requirements of those laws as may be applicable to the Local SDSP. (15) A Local SDSP must develop and implement a plan to increase parental/guardian permission return rates to receive dental sealant services. (16) A Local SDSP must respect classroom time and limit demands on school staff. Services must be delivered efficiently to ensure a student’s time out of the classroom is minimal. (17) A Local SDSP must use sealant materials and placement techniques consistent with school dental sealant program best practices and manufacturers’ instructions. (18) A Local SDSP must develop accessible digital and written forms and materials consistent with health literacy and plain language guidelines. (19) A Local SDSP must communicate with assigned schools to engage them in services using methods such as electronic mail, telephone, or in-person communication. (20) A Local SDSP must submit annually to the Program a Quality Monitoring and Evaluation Plan that is approved by the Program. The Quality Monitoring and Evaluation Plan must describe how the Local SDSP will collect, analyze, and report program data. At a minimum, a Local SDSP must collect and analyze the data elements required by the Program and include those data in its Quality Monitoring and Evaluation Plan. A Local SDSP must submit program data to the Program in the format, method, and timeline specified by the Program. (a) Each Local SDSP must develop and maintain a Quality Monitoring and Evaluation Plan specific to its program operations. (b) A Local SDSP must comply with any request from the Program for information related to the Quality Monitoring and Evaluation Plan. (c) The Quality Monitoring and Evaluation Plan must describe how the Local SDSP will: (A) Adhere to current evidence-based clinical guidelines, standards of care, and standards of practice in the provision of school dental sealant services; (B) Collect and evaluate program data. (i) A Local SDSP must collect and evaluate the following data elements: (I) Assigned schools’ engagement; (II) Grades served; (III) Number of students screened for dental sealants, by grade; (IV) Number of students who received one or more dental sealants, by grade; (V) Number of dental sealants placed, by school aggregate; (VI) Number of students with Basic Screening Survey (BSS) early or urgent care referrals; (VII) Number of “Yes” permission forms returned, by school, to the Local SDSP; and (VIII) Number of “No” permission forms returned, by school, to the Local SDSP. (ii) In addition to the data required under subparagraph (17)(c)(B)(i) of this rule, a Local SDSP must select at least two additional data elements with approval from the Program. (C) Identify, analyze, and address client safety concerns and adverse events. The Quality Monitoring and Evaluation Plan must address: (i) Obtaining consent for services; (ii) Adherence to manufacturers’ instructions or materials and equipment; (iii) Adherence to infection prevention and control protocols; and (iv) Compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA), as may be applicable to the Local SDSP. (D) Describe the policies, procedures, and activities the Local SDSP will use to implement the requirements of the Program and the Quality Monitoring and Evaluation Plan. (E) A Local SDSP must evaluate its Quality Monitoring and Evaluation Plan at least twice during each school year and make adjustments to the plan or program as needed. (i) A Local SDSP must submit to the Program, twice per school year, a Quality Improvement and/or Quality Assurance (QI/QA) assessment that reports progress on implementing the Quality Monitoring and Evaluation Plan and describes any follow-up actions taken in response to issues identified under subsections (17)(a), (b), and (c) of this rule. (ii) The Quality Improvement and/or Quality Assurance (QI/QA) assessment must: (I) Identify any areas where Program policies, protocols, clinical guidelines, or Program requirements are not being followed or are not effectively implemented; (II) Analyze factors contributing to the identified issue; and (III) Describe corrective actions or program improvements implemented to address the issue. (iii) A Local SDSP must notify the Program of any mid-school-year changes to the Quality Monitoring and Evaluation Plan, or report that no changes are required. (iv) Submissions required under paragraph (20)(c)(E) of this rule must be submitted no later than: (I) February 1 for the mid-school-year update; and (II) June 15 for the end-of-school-year update. (21) A Local SDSP must include the certification logo provided by the Program on all parent/guardian permission forms and written communication to schools or provide schools with a letter provided by the Program indicating the Local SDSP is certified.