INSTRUCTIONS FOR THE CAREER OPTIONS TOOLKIT TEMPLATE
This is a template you can use to build an instructional toolkit that will inform dental hygienists about the
particular direct access practice opportunity in your state. Every state is different, so every toolkit will be
different. The template format contains the essential elements you will need to include in the toolkit, plus
some additional items that may or may not be pertinent for your state.
Please note that the printed text is in one of four different colors, designed to guide you through the process.
The RED text is an instruction, which will be deleted from the final toolkit.
The BUE text is sample language that suggests how you might draft the correct information for your
state. For example, there is a sample description of collaborative practice. Your state may or may not have
collaborative practice—you might have public health supervision or some other kind of direct access
practice. Even if your state has collaborative practice, the exact details of the description will need to be
crafted to fit your state’s circumstances. Every state will need to replace the BLUE text with the correct
information specific to their state.
The GREEN text indicates that you must fill in specific information. Usually this will be state specific contact
information or a state specific web address, etc.
The BLACK text is explanatory material to include verbatim in the final toolkit. It is information that is the
same regardless of state.
Once you have created your toolkit, you decide how to distribute it—perhaps add it to your state
association’s website and promote the link on facebook. Check the final toolkit to be sure the printed version
is all black type. If you would like ADHA staff input on the project, need help locating information, or just
want to chat about it, please call Governmental Affairs at 312-440-8925.
Choose a name for your toolkit. Be sure to include the name of your state!
Starting your own Collaborative Practice/Understanding
how to Practice as an RDHAP/LAP, How to be a Direct
Access RDH, How to practice as a Direct Access RDH
Insert your state
association‘s logo &
contact information
Collaborative Practice: Is it Right for You?
Insert Language Explaining Direct Access in your State
The following is an example, using a generic description of collaborative practice, of how you
might construct some paragraphs describing practice, substituting the correct information for
your state. It should include basic qualifications, settings, services, and a description of any
legally required relationship with a dentist. Sample text:
Have you ever wondered what direct access dental hygiene practice options are available that
would offer you a professional challenge, open doors to new opportunities, provide the
unique satisfaction that accompanies being able to provide services to people unable to obtain
them? Then you may want to investigate practice as a (LAP hygienist, collaborative practice
hygienist, public health hygienist, etc.) as a new career option, as a part-time vocation, or even
on an occasional or volunteer basis.
Collaborative practice means that the dental hygienist has established a written agreement
with a dentist who has agreed to monitor treatment of patients and consult as needed. The
dental hygienist and dentist jointly establish a protocol that describes the services the hygienist
may provide without the dentist’s authorization.
• Indicate what
settings provider
can work in (i.e.
schools, nursing
homes, etc)
• (Indicate any
settings where
practice is
prohibited)
• TIP – Use bullet
points to list, for
a user-friendly
way to deliver
information
Services
• Insert Specific
Qualifications
(i.e. must have
2,000 hours of
active practice in
last 5 years,
Bachelors degree
etc.)
• If additional
coursework is
required,
describe
• If permit or
specific state
authorization is
required,
indicate
Settings
Educational & Experiential Requirements
Requirements for Practice as a Collaborative Hygienist
• Specify what
services are
allowable (i.e.
prophylaxis,
sealants,
fluorides,
radiographs, etc)
• Indicate if your
state allows for
direct MEDICAID
reimbursement
of dental
hygienists under
Medicaid.
Practice as Collaborative Hygienist –
What Else Do I Need to Know?
Fill in the correct name for Direct Access Practice in your state. The previous two slides
described practice parameters, now use this area to link the reader to the policies and rules
in your state that govern direct access practice. Below is an area where you can offer links to
your state dental board website and other sites that have relevant information.
Statutes & Rules
State Dental Practice Act:
www.website.abc
Link to Dental Board Rules:
www.website.abc
Applicable Forms
Link to Applications and Forms:
www.website.abc
Board of Dentistry Website:
www.website.abc
Other links
Business Considerations
If direct access practice in your state implies or allows business ownership or independent
contracting, you will want to offer some basic information about those issues. Text you can use
with links follows, although you can supplement with additional state-specific information.
If you are self-employed you will be responsible for paying your own social security and federal and
state income taxes directly to the government. To learn more about income reporting
requirements, visit: http://www.irs.gov/businesses/small/index.html
If you take the next step and become a small business (i.e. hire employees or do business as some
kind of business entity) then you are also required to obtain a free employer identifier number
(EIN) to use on tax and other business filings. For more information, visit:
IRS - Employer ID Numbers (EINs) ;
IRS - Employer ID Numbers (EIN) - How to Apply
A "DBA" (also known as Doing Business As) is a legal name you decide to give your business. You
may want to name your business to present a more professional image, heighten the visibility of
your business and accept checks using a business account.
For more business information check out the Small Business Association’s Website.
http://www.sba.gov/category/navigation-structure/starting-managing-business/starting-business/
Insurance & Liability
Why you need professional liability insurance!
Insurance coverage held by the employer is written to protect the employer and
patients served by the employer. Individual employees have limited protection and
limited access to the legal defense services provided to the policy holder.
If you are self-employed you need individual protection for yourself and your business
even more so. Professional liability insurance coverage is generally restricted to
matters relating to patient care - it will not cover loss or damage to equipment, general
negligence issues or other matters.
ADHA offers great information on professional liability and other types of insurance for
self-employed dental hygienists, as well as equipment replacement insurance at:
https://www.personal-plans.com/adha/welcome.do
Payment: Reimbursement
from Insurance Agencies
You may want to offer additional information about reimbursement for services in your
state. For example, if there is a specific statute/rule in place that requires insurers to
reimburse dental hygienists, indicate that. If you are aware of other policies in your
state that impact reimbursement, include that information. The text below offers some
general information on reimbursement of dental hygienists by private insurers. You can
use the information as written or modify to fit your state.
Many, but not all, private insurance companies will reimburse dental hygienists. Some
of these will reimburse patients, but not pay the dental hygienist directly. Some might
limit the codes they will reimburse to dental hygienists.
It is prudent to discuss with the patient that reimbursement can be withheld, leaving
them responsible for payment, or that they may need to submit for reimbursement
themselves.
To order the CDT manual of dental codes see: http://www.ada.org/3836.aspx
Payment: Reimbursement
by Medicaid
Currently, 15 states (AZ, CA, CO, CT, ME, MA, MN, MO, MT, NE, NM, NV, OR, WA, and
WI) allow dental hygienists to be directly reimbursed by Medicaid. Each state Medicaid
program has the reach to identify the types of providers it reimburses for services. If
your state does not directly reimburse dental hygienists, omit this page from your
document. The following text can be used as a guide for states that do allow for direct
reimbursement.
Medicaid will reimburse dental hygienists who (description of settings or of types of
patients) for the following services: prophylaxis, sealants
To apply to be a provider, contact the state Medicaid agency at: (Insert web link and
name of agency and contact information to the provider services section)
Payment: NPI
In order to file an electronic claim to a third party payer, whether private insurance or
Medicaid, you need your own National Provider Identifier (NPI).
An NPI is a 10 digit number, assigned for free by the federal government, that serves as
a permanent identifier of you as a healthcare provider, even if you move or are
relicensed in a different profession.
Even if you do not anticipate billing third parties directly, it is probably a good idea to
apply for the free NPI anyway because it may facilitate billing actually submitted by a
health department or other entity for services that you provided.
For more information about the NPI and how to obtain one, please visit the NPPES
website or https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
or contact NPPES directly by phone at (800) 465-3203.
Additional State Resources
Insert information about state-specific resources that may be available to direct
access dental hygienists, such as:
•Continuing education courses for direct access practice hygienists
• Contact information for experienced practitioners who are willing to mentor
newcomers
•Associations or other allied groups of direct access practitioners, willing to assist
newcomers
•Listservs, Facebook pages, LinkedIn groups etc for direct access dental
hygienists
•Websites involved with direct access dental hygiene practice
•Contact information for your state association (website, e-mail address(es),
phone number
Insert your state
association’s logo &
contact information
ADHA Resources
•The Working column in Access magazine highlights on dental hygienists
who have pursued a variety of career paths:
http://www.adha.org/publications/working/working.htm
• ADHA’s Standards for Clinical Dental Hygiene Practice:
http://www.adha.org/downloads/adha_standards08.pdf
•ADHA’s Public Health Listserv is a forum to exchange information about
careers and practice in public health:
http://adha.org/lists/index.htmlhttp://adha.org/lists/index.html
•ADHA on facebook:
http://www.facebook.com/youradha
• ADHA on Linkedin:
http://www.linkedin.com/groups?gid=2875805&trk=hb_side_g