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Coronavirus COVID-19

Updated 3/27/2020.

The MDS continues to monitor the outbreak of the coronavirus and COVID-19 and will keep members informed of any new developments and recommendations. Please be sure to read all the communications we send you and continue to check the Centers for Disease Control and Prevention, American Dental Association, and Massachusetts Department of Public Health websites for the most current information and updated guidelines.

This dedicated webpage, which is updated as information is made available, is accessible to non-members, as well.

MDS Guidance on Closing Dental Offices to Elective and Non-Urgent Care

3/19/2020

The MDS Issues Guidance on COVID-19 (3/15/2020)

As the facts and situation around coronavirus and COVID-19 continue to evolve, and in step with Governor Baker’s recent Declaration of a State of Emergency, the Massachusetts Dental Society (MDS) Executive Committee and Board of Trustees is issuing the following guidance for dentists in Massachusetts.

The MDS strongly recommends that dentists practicing in the Commonwealth close their offices from March 17 to April 6 to patients seeking elective and non-urgent care. As always, it is expected that dentists will continue to be available as needed for emergency management.

This is not guidance we are issuing lightly, and it is being done out of an abundance of caution during these turbulent times. As health care professionals, we all have a role to play in slowing the spread of the coronavirus and “flattening the curve” in order to follow sound scientific, public health advice, help limit infections, and slow the spread of the virus.

The spread of COVID-19 will be determined by our collective actions now, and this recommendation is being made out of an abundance of caution. We believe by taking these extraordinary precautions, dentists can make a difference in helping to preserve the limited supply of personal protection equipment (PPE) critical for emergency dental care and frontline health care personnel responding to the pandemic.


DPH and BORID Fully Endorse MDS Guidance on Office Closures (3/18/2020)
 
The Massachusetts Department of Public Health (DPH) and the Board of Registration in Dentistry (BORID) released a recommendation on March 18, fully endorsing the guidance issued by the MDS.

Read Recommendation


Communicating with Patients on Temporary Office Closures

To help dentists notify their patients of temporary office closings during this public health crisis, we have created a sample letter that dentists can personalize and post on websites or social media channels.

Interim Emergency Dental Practice Guidance

3/17/2020

As dental practitioners transition to an emergency treatment–focused dental practice following the MDS’s strong recommendation that Massachusetts dental offices close to patients seeking elective or non-urgent care, the MDS is providing interim guidelines to help dentists determine which procedures are emergent or urgent and which are elective and non-urgent.

 

Dental Practice Protocols

3/23/2020

To protect against transmission of the novel coronavirus and the disease it causes, COVID-19, it’s important that your practice's infection control procedures and protocols are up-to-date and enforced.

If it is necessary to treat patients requiring emergency care, remind your staff that the continued use of standard infection control precautions keeps everyone safe. Review the U.S. Centers for Disease Control and Prevention's (CDC) Standard Precautions Guidelines for infection prevention and control in dental settings and make sure that they are being followed. 

The DPH and BORID issued a recommendation stating that dentists who keep their dental practices open are required to practice in compliance with the U.S. Centers for Disease Control (CDC) Guidelines for Infection Control in the Dental Healthcare Setting per the BORID’s regulations at 234 CMR. Additionally, if a dentist is treating a patient diagnosed with COVID-19 or suspected of having been exposed to the virus, then the treating dentist and any auxiliary staff involved in that treatment should follow the CDC’s Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease (COVID-19) in Healthcare Settings and utilize N95 respirators and surgical face masks/gowns per the recommendations of the U.S. Food and Drug Administration, the CDC, the National Institute for Occupational Safety and Health, and the Occupational Safety and Health Administration. 

All dentists should limit the number of dental staff and patients present in their offices to prevent the spread of COVID-19.

You should develop a coverage plan for emergency cases in the event that staff members need to self-quarantine. Any staff member with symptoms of respiratory illness should be encouraged to stay home and consult their doctor. 

The CDC's "What You Need to Know About COVID-19 Coronavirus Disease" factsheet provides, in straightforward language, an overview of the coronavirus, information on how it is spread, symptoms of the respiratory illness, and how to protect yourself from contracting and spreading the disease. 

Continue to visit the following websites for additional preventive measures and COVID-19 resources:

Risk Management Issues to Consider During the Coronavirus Pandemic

3/25/2020

Dental practitioners are facing many unknowns as a result of the coronavirus pandemic, including potential risk management issues. Massachusetts Dental Society (MDS) Member Savings Program Partner Eastern Dentists Insurance Company (EDIC), the malpractice insurance provider founded by the MDS and member dentists, has shared answers to some risk management questions posed by its dentist clients in recent days, such as:

  • Can I be sued by patients or employees if they get COVID-19 from my office? 
  • Do I need to use the N95 respirator?
  • Do you have a sample informed consent form available for patients that come in for care during the pandemic

Download Q&A

COVID-19 Patient Waiver

The MDS recommends obtaining a signed consent waiver when treating patients during this time. To assist dental practices in developing their own waiver forms, the MDS has developed a sample consent waiver for patients. Be sure to check with your own legal counsel or risk management insurer to confirm that any waiver meets your specific needs.

Download Sample


Coding for Teledentistry

With dental practices in Massachusetts closed to all but emergency procedures, and taking into consideration that some dental offices may have the capability to perform evaluations remotely, several dental insurers are updating their policies to include coverage of teledentistry.  

Delta Dental
On Friday, March 20, 2020, Delta Dental of Massachusetts announced an interim policy allowing for teledentistry or virtual exams. Effective March 20, and for a period of 30 days, offices that have the capability to perform evaluations via audio or video technology should submit the claim using the Oral Evaluation – Problem-Focused code (D0140) when performing virtual evaluations for Delta Dental of Massachusetts accounts. The claim will be paid if the patient has Delta Dental of Massachusetts insurance and has coverage/benefits available.

Blue Cross
Blue Cross Blue Shield of Massachusetts announced that effective March 23, 2020, and until further notice, it will cover consultations by telephone or video (“virtual consultations”) between dental providers and their patients, for all members who already have coverage for problem-focused exams (D0140), with no cost share (deductible, copayment, or co-insurance). Per Blue Cross, dental offices can report virtual consultation services using CDT code D0140 (Limited Oral Evaluation – Problem Focused). Virtual consultations should be patient-initiated and related to a specific dental problem that would otherwise have required an in-person office visit. Blue Cross is instructing providers to document in the patient’s chart the problem that necessitated the telephone or video consultation and what you recommended to the patient.

MassHealth
The MassHealth Dental Program approved the ability for dental services to be provided via telehealth for both MassHealth and HSN beginning March 12, 2020. The billing system has been updated to accept claims when billed with place of service telehealth, and the MassHealth Provider Web Portal has been updated to provide place of service option telehealth. If the option to bill telehealth is not available to submit EDI claims, please submit all telehealth claims utilizing the provider web portal choosing place of service option. Per the MassHealth All Provider Bulletin 289, the test for whether you can bill something to MassHealth via place of service telehealth (which includes both live video and telephone) is:

  • Were you able to bill it to MassHealth and be paid before?
  • Is it clinically appropriate to be delivered via telehealth? 
  • Is it medically necessary for the member?
  • Are you conforming with the guidance in Appendix A of the Provider Bulletin 289?
If the answer to these questions is “yes,” then the visit can be billed and paid by MassHealth at the rate previously paid using the codes that are appropriate for the service(s) provided. Please note that MassHealth is not adopting specific telehealth codes, changing frequencies/limitations, or waiving eligibility or provider credentialing requirements.
If you need further clarification on filing a teledentistry claim with one of the insurers listed above, please contact them directly. If your practice accepts dental insurance from a carrier not listed above, you should reach out to them to ask if they are covering teledentistry or virtual exams.

As a reminder, dental practices that engage in teledentistry need to be mindful of patient privacy during any sessions.

ADA COVID-19 Coding and Billing Interim Guidance

The ADA has released a guide intended to help dental offices navigate issues related to coding and billing for virtual check-ins in the midst of the COVID-19 outbreak. Available on the ADA Center for Professional Success, the guide was created because telecommunication technology can be leveraged to support dental evaluations during this national effort to reduce non-emergency services.

Read Guide

Answers to Staffing Questions

3/26/2020

Answers to Your Questions About Furloughs and Layoffs

With many dental practices across the state now closed as a result of the ongoing COVID-19 pandemic, dental practice owners have been forced to make difficult staffing choices, such as whether to furlough or lay off staff. To help members and their staff better understand the impact of these staffing decisions on both their employees and their practice, the MDS has produced a resource (link to accordion or PDF) that details the differences and provides answers to common questions regarding furloughs and layoffs.

Read Q&A

Sample Furlough Letter

Due to the COVID-19 pandemic and the recommendation that dental offices close to all elective and non-urgent care, many dental practices are facing challenges and have been forced to make difficult personnel decisions, including furloughing staff. To help dentist practice owners notify their staff of a furlough during this public health crisis, the MDS has created a sample letter that dentists can personalize. Please note that employers and their furloughed employees are required to check in with each other weekly pursuant to Department of Unemployment Assistance regulations.

Download Sample Letter

Answers to Staffing Questions

To help answer your staffing questions related to dental office closures as a result of COVID-19, the MDS has developed a Q&A resource summarizing answers to frequently asked questions. Please note that this guidance is not a substitute for legal advice, and we recommend that you seek appropriate legal counsel for answers to more specific questions.

Some of the questions that are addressed include:
  • Do I need to pay staff during a shutdown?
  • What is the difference between a layoff and a furlough?
  • Can staff qualify for unemployment assistance if they are still technically employed?
  • Can I mandate that my staff come into work for emergency care? 

Download Q&A

MDS Webinar on Staffing Questions in Connection with a Temporary Office Closure

Have you already or are you considering closing your office temporarily due to COVID-19? MDS attorneys from Goulston and Storrs discuss details related to staffing issues in connection with office closures during this pandemic.

View Webinar




Unemployment Assistance

3/25/2020

The Massachusetts Executive Office of Labor and Workforce Development (EOLWD) and the Department of Unemployment Assistance (DUA), in coordination with the U.S. Department of Labor (USDOL), are taking a series of actions to assist workers and employers.

Learn More


MDS Unemployment Insurance Q&A

To help dental offices navigate various unemployment resources, the MDS has compiled a memo summarizing available information and providing answers to questions received by member dentists.

Download Unemployment Insurance Q & A


Action for Employers: Locating Your UI Login Information

Dental practice owners who have laid off or furloughed staff, or who plan to, should make sure to know their business’s Unemployment Insurance (UI) login information or otherwise obtain it from their payroll person/business manager. In the process of closing an office, the dentist should change that designated person to himself or herself in order to receive timely notification of any claims. Email notifications will come from the UI system to the designated individual informing them of a furloughed or laid-off employee’s unemployment claim filing. The individual who receives the email will then be required to log in and respond to the Department of Unemployment Assistance’s (DUA) information requests.

If you have employees and have been paying into UI, you should already be registered as an employer with the DUA. If you are an employer and have not registered as an employer with the DUA, you will need the following information to complete your registration:

  • Doing business as (DBA) name
  • Federal Employer Identification Number (FEIN)
  • State and date of formation or incorporation
  • Date that employees first began work in Massachusetts
  • Owner/officer information including: Social Security number (SSN), FEIN, and percent of ownership
  • North American Industry Classification System (NAICS) code: Dentists should use NAICS Code 621210 – Offices of Dentists (DMD DDS)
  • Principle business activity performed in Massachusetts
  • Quarterly gross summary of wages paid to date
  • Number of employees currently on payroll

There are a couple of ways for you to get your Employer UI username.

  1. Do you have an outside service company that processes your payroll – they may have the number. 
  2. At least annually your practice should receive a letter from unemployment notifying you of your experience rating for the year.  Your UI number should be on those letters.  Find out where those letters have been filed.  Once you have the UI number you can reset your password via the instructions below. 
  3. Go the unemployment website https://www.mass.gov/unemployment-insurance-ui-online to get your UI User ID. Click on the drop down menu under LOG IN TO you will come to a page with the following  box 

Unemployment Insurance online screenshot

Small Business Relief for Dental Offices

3/24/2020

Visit the mass.gov small business relief webpage for the most current information. 

Small Business Administration Economic Injury Disaster Loan Program

The U.S. Small Business Administration (SBA) will offer low-interest federal disaster loans for working capital to Massachusetts small businesses suffering substantial economic injury as a result of COVID-19. Small businesses that have been financially impacted as a direct result of the coronavirus (COVID-19) since January 31, 2020, may qualify for Economic Injury Disaster Loans of up to $2 million to help meet financial obligations and operating expenses that could have been met had the disaster not occurred. Eligibility for Economic Injury Disaster Loans is based on the financial impact of COVID-19. The interest rate is 3.75% for small businesses. SBA offers loans with long-term repayments in order to keep payments affordable, up to a maximum of 30 years, and are available to entities without the financial ability to offset the adverse impact without hardship. Visit disasterloan.sba.gov/ela to apply. Applicants may also call SBA’s Customer Service Center at 800.659.2955 or email disastercustomerservice@sba.gov for more information on SBA disaster assistance. Individuals who are deaf or hard of hearing may call 800.877.8339. Completed applications should be mailed to U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX  76155. The deadline to apply for an Economic Injury Disaster Loan is December 18, 2020.


PPE Inventory and Donations

3/24/2020

The MDS advises you to check your inventory of personal protective equipment (PPE), specifically gloves and masks, to be sure you have an adequate supply for emergency care.

The CDC is providing current updates and guidance on any PPE shortages, including information from suppliers and distributors.

PPE Donations

The Massachusetts Dental Society (MDS) has received calls from many dental offices looking for information on where they can donate supplies to help frontline health care workers who are responding to the COVID-19 pandemic. Massachusetts Health and Human Services Secretary Marylou Sudders also has issued an urgent call to all Massachusetts dental providers to consider donating existing supplies of N95 respirator masks and/or surgical masks to the Massachusetts Department of Public Health.

The Massachusetts Emergency Management Agency (MEMA) is operating a State Logistics Warehouse to receive and distribute emergency supplies to first responders across the Commonwealth who are responding to COVID-19.

What Is Needed: MEMA is in need of unopened supplies, including:
  • Gloves
  • Eye masks
  • Gowns, booties
  • Face masks (with or without eye shields)
  • Respirators (N95, N99, N100, etc.) 
  • Cleaning products such as sanitizing wipes and surface disinfectants
  • Hand sanitizer 
How to Donate: 

Supplies can be dropped off at the warehouse by appointment only. It may be possible for MEMA to coordinate a pickup of donations. Requests for appointments for delivery or pickup of donations and inventory intake can be sent to MEMA by emailing donationsdeskmema@gmail.com. When emailing, please provide as much information on the items, quantity, and a point of contact.

Where to Drop Off: The warehouse is located in Marlborough. The exact location will be released upon arrangement of donation. Please do not distribute this location to other entities outside of this correspondence.

MEMA is encouraging offices to consolidate deliveries to minimize the number of vehicles and deliveries at the warehouse, if at all possible. If you can coordinate with other providers to gather geographic collections for delivery, that would be most helpful.

On March 21, the MDS coordinated with nine Districts to arrange donation sites that collected more than 150,000 items donated by dentists.

Every donation can make a difference. If you would like to discuss your donation options with the Statewide COVID-19 Response Command Center, you may contact Kim Christoforou at kimberly.christoforou@umassmed.edu.

If you work with a hospital or medical center that is in need of PPE, please contact supplyhub@massbio.org and the information will be shared with the Massachusetts Department of Public Health, which is coordinating and triaging all requests for supplies.

Professional Licensure Deadline Extended

3/20/2020

Governor Charlie Baker has issued an order directing the extension of registrations for professional licenses that are in good standing as of March 18 and have expired or will expire during the current state of emergency. Through collaboration with the administration, the MDS worked to ensure that this order applies to dentists who would have been required to renew their licenses through the Board of Registration in Dentistry (BORID) by March 31, 2020. The MDS will collaborate with BORID over the next few weeks to determine the policies related to this order.

The extension shall remain valid until 90 days following the termination of the state of emergency, which remains in effect until notice is given, pursuant to the judgment of the governor, that the state of emergency no longer exists.

Read Order


Personal Help Hotlines

The COVID-19 pandemic is disrupting our everyday routines and presenting new challenges for work and family life. If you or someone you know needs help during this time, please don’t hesitate to reach out to any of the helplines below: 

MDS Suspends Programs and Meetings

Recorded March 11, 2020.



The Massachusetts Dental Society values the health and well-being of all our members and the public-at-large. On March 10, Governor Charlie Baker declared a State of Emergency in Massachusetts to support the Commonwealth’s response to the coronavirus outbreak. The MDS announced on March 11 that we will follow the governor’s recommendation and effective immediately, the MDS is instituting the following policy for the next 30 days: 

  • All in-person meetings scheduled for the next 30 days will move to virtual when possible or will be rescheduled/canceled as necessary. If you have an MDS-related meeting scheduled during this timeframe, please patiently await a communication regarding any potential changes to that meeting.
  • In light of this new policy and careful consideration of all available information, it was determined that Beacon Hill Day will be canceled this year. The MDS will evaluate virtual advocacy opportunities over the coming days and communicate that information to all members.
  • In addition, the MDS Dentist Health and Wellness Program "Beyond the Mask" will be postponed.
  • We further recommend that our Districts also adhere to Governor Baker’s recommendation and cancel or postpone all in-person gatherings. The MDS will be providing Districts with virtual meeting tools to help conduct District business.

The MDS will continue to monitor this situation and keep members informed of any new developments and/or recommendations. We encourage members to review the CDC website and the ADA website for the most current information and updated guidelines. Also, please be sure to read all communications from the MDS regarding this emergency.

It is important to stay calm and informed. If you have any questions, please contact the MDS Member Assistance Center (MAC) at 800.342.8747.