From Your Regulatory Compliance Specialist – Linda Cannon. COVID-19 Update#21
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Quick Guide to Newsletter’s Content:
ADA explains how No Surprises Act could affect dentists
Know Your COVID-19 Community Level
Ending Isolation and Precautions for People with COVID-19: Interim Guidance
ADA providing guidance on updated mask recommendations from CDC
How to Heal Post-Vaccine and Counter Effects
FAQs | Masks + COVID-19 Vaccination
ADA explains how No Surprises Act could affect dentists
Good faith estimates now required for uninsured/self-pay consumers
The ADA has received questions from member dentists regarding the No Surprises Act and whether it affects dental practices.
The No Surprises Act went into effect Jan. 1 and gives consumers new billing protections when getting emergency care, nonemergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
The law’s protections against balance billing largely do not affect private dental offices because dental benefits are excepted benefits, according to the Centers for Medicare and Medicaid Services. The new requirements on balance billing generally apply to items and services provided to consumers enrolled in group health plans, group or individual health insurance coverage, as well as federal employees’ health benefits plans, but not excepted dental benefit plans. These requirements are based on the current rules as of Jan. 14. If anything changes, the ADA will let member dentists know.
In the case of major medical coverage, the ADA believes that it is possible that dental components could be affected. The question would come down to whether the dental coverage is classified as one of the categories of services that these protections apply to. The ADA believes if the dental component is an excepted benefit, most dentists will not have to worry about making that determination initially. The exception would be in rare instances where the dispute resolution and arbitration requirements apply to dental because they are site specific to hospitals and ambulatory centers.
The separate requirements of the law for transparency of health care costs and the requirements related to the patient-provider dispute resolution process do apply to uninsured (or self-pay) consumers who visit a private dental office. Good faith estimates are now required to be given to those uninsured (or self-pay) consumers who request the estimate or schedule a service, according to the Centers for Medicare & Medicaid Services.
Providers or facilities will have three business days to give good faith estimates in writing after a request and all providers and facilities that schedule items or services for an uninsured (or self-pay) individual or receive a request for a good faith estimate from an uninsured (or self-pay) individual, must provide such individual with a good faith estimate. No specific specialties, facility types, or sites of service are exempt from this requirement, CMS said, so private dental offices are included. A paper or printable electronic copy of the good faith estimate is required and an uninsured (or self-pay) individual could initiate a patient-provider dispute resolution process if their actual billed charges exceed their good faith estimate by at least $400.
To assist providers, CMS is sharing the following resources:
• Model Notices and Information Requirements for the good-faith estimate and patient-provider payment dispute resolution.
• Guidance on good faith estimates and the Patient-Provider Dispute Resolution process for people without insurance or who plan to pay for the costs themselves.
• Guidance on good faith estimates and the Patient-Provider Dispute Resolution Process for providers and facilities.
• Guidance for Selected Dispute Resolution Entities: Required steps to making a payment determination under the Patient-Provider Dispute Resolution process.
• Fee guidance for the Federal Patient-Provider Dispute Resolution process in 2022.
The requirements of the No Surprises Act do not apply to people with coverage through programs such as Medicare, Medicaid, the Indian Health Service, Veterans Affairs Health Care or TRICARE. These programs have other protections against surprise bills. Further, as of now, with regards to good faith estimates and consumers who are enrolled in or are using health insurance, the U.S. Department of Health and Human Services has not issued rulemaking related to the provision of good faith estimates for those individuals and will defer enforcement for those consumers until adopted.
The ADA continues to monitor this evolving issue and will share any updates the Association receives. This article is not, and should not, be considered legal advice.
https://www.ada.org/publications/ada-news/2021/december/ada-addresses-no-surprises-act-questions
COVID-19 by County
Know Your COVID-19 Community Level
COVID-19 Community Levels are a new tool to help communities decide what prevention steps to take based on the latest data. Levels can be low, medium, or high and are determined by looking at hospital beds being used, hospital admissions, and the total number of new COVID-19 cases in an area. Take precautions to protect yourself and others from COVID-19 based on the COVID-19 Community Level in your area.
What Prevention Steps Should You Take Based on Your COVID-19 Community Level?
Ending Isolation and Precautions for People with COVID-19: Interim Guidance
CDC’s new COVID-19 Community Levels recommendations do not apply in healthcare settings, such as hospitals and nursing homes. Instead, healthcare settings should continue to use community transmission rates and continue to follow CDC’s infection prevention and control recommendations for healthcare settings.
Key Points for Healthcare Professionals
- Children and adults with mild, symptomatic COVID-19: Isolation can end at least 5 days after symptom onset and after fever ends for 24 hours (without the use of fever-reducing medication) and symptoms are improving, if these people can continue to properly wear a well-fitted mask around others for 5 more days after the 5-day isolation period. Day 0 is the first day of symptoms.
- People who are infected but asymptomatic (never develop symptoms): Isolation can end at least 5 days after the first positive test (with day 0 being the date their specimen was collected for the positive test), if these people can continue to wear a properly well-fitted mask around others for 5 more days after the 5-day isolation period. However, if symptoms develop after a positive test, their 5-day isolation period should start over (day 0 changes to the first day of symptoms).
- People who have moderate COVID-19 illness: Isolate for 10 days.
- People who are severely ill (i.e., requiring hospitalization, intensive care, or ventilation support): Extending the duration of isolation and precautions to at least 10 days and up to 20 days after symptom onset, and after fever ends (without the use of fever-reducing medication) and symptoms are improving, may be warranted.
- People who are moderately or severely immunocompromised might have a longer infectious period: Extend isolation to 20 or more days (day 0 is the first day of symptoms or a positive viral test). Use a test-based strategy and consult with an infectious disease specialist to determine the appropriate duration of isolation and precautions.
- Recovered patients: Patients who have recovered from COVID-19 can continue to have detectable SARS-CoV-2 RNA in upper respiratory specimens for up to 3 months after illness onset. However, replication-competent virus has not been reliably recovered from such patients, and they are not likely infectious.
Recommendation for Ending Isolation
For people who are mildly ill with a laboratory-confirmed SARS-CoV-2 infection and not moderately or severely immunocompromised:
– Isolation can be discontinued at least 5 days after symptom onset (day 1 through day 5 after symptom onset, with day 0 being the first day of symptoms), and after resolution of fever for at least 24 hours (without the use of fever-reducing medications) and with improvement of other symptoms.
– Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.
-These people should continue to properly wear a well-fitted mask around others at home and in public for 5 additional days (day 6 through day 10 after symptom onset) after the 5-day isolation period.
-People who cannot properly wear a mask, including children < 2 years of age and people of any age with certain disabilities, should isolate for 10 days. In certain high-risk congregate settings that have high risk of secondary transmission and where it is not feasible to cohort people, CDC recommends a 10-day isolation period for residents.
For people who test positive, are asymptomatic (never develop symptoms) and not moderately or severely immunocompromised:
– Isolation can be discontinued at least 5 days after the first positive viral test (day 0 through day 5, with day 0 being the date their specimen was collected for the positive test).
– These people should continue to properly wear a well-fitted mask around others at home and in public for 5 additional days (day 6 through day 10) after the 5-day isolation period. Day 0 is the date their specimen was collected for the positive test and day 1 is the first full day after the specimen was collected for the positive test.
– If a person develops symptoms after testing positive, their 5-day isolation period should start over (day 0 changes to the first day of symptoms).
-People who cannot properly wear a mask, including children < 2 years of age and people of any age with certain disabilities, should isolate for 10 days. In certain high-risk congregate settings that have high risk of secondary transmission and where it is not feasible to cohort people, CDC recommends a 10-day isolation period for residents.
For people who are moderately ill and not moderately or severely immunocompromised:
– Isolation and precautions can be discontinued 10 days after symptom onset (day 1 through day 10, with day 0 being the first day of symptoms).
For people who are severely ill and not moderately or severely immunocompromised:
– A test-based strategy can be considered in consultation with infectious disease experts.
– Some people with severe illness (e.g., requiring hospitalization, intensive care, or ventilation support) may produce replication-competent virus beyond 10 days that may warrant extending the duration of isolation and precautions for up to 20 days after symptom onset (with day 0 being the first day of symptoms) and after resolution of fever for at least 24 hours (without the use of fever-reducing medications) and improvement of other symptoms.For people who are moderately or severely immunocompromised (regardless of COVID-19 symptoms or severity):
- Moderately or severely immunocompromised patients may produce replication-competent virus beyond 20 days. For these people, CDC recommends an isolation period of at least 20 days, and ending isolation in conjunction with a test-based strategy and consultation with an infectious disease specialist to determine the appropriate duration of isolation and precautions.
- The criteria for the test-based strategy are:
- Results are negative from at least two consecutive respiratory specimens collected ≥ 24 hours apart (total of two negative specimens) tested using an antigen test or nucleic acid amplification test.
- Also, if a moderately or severely immunocompromised patient with COVID-19 was symptomatic, there should be resolution of fever for at least 24 hours (without the use of fever-reducing medication) and improvement of other symptoms. Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.
- Re-testing for SARS-CoV-2 infection is suggested if symptoms worsen or return after ending isolation and precautions based on this test-based strategy for moderately or severely immunocompromised people.(1)
- If a patient has persistently positive nucleic acid amplification tests beyond 30 days, additional testing could include molecular studies (e.g., genomic sequencing) or viral culture, in consultation with an infectious disease specialist.
- For the purposes of this guidance, moderate to severely immunocompromising conditions include, but might not be limited to, those defined in the interim clinical considerations for people with moderate to severe immunocompromise due to a medical condition or receipt of immunosuppressive medications or treatments.
- Other factors, such as end-stage renal disease, likely pose a lower degree of immunocompromise, and there might not be a need to follow the recommendations for those with moderate to severe immunocompromise.
- Ultimately, the degree of immunocompromise for the patient is determined by the treating provider, and preventive actions should be tailored to each patient and situation.
ADA providing guidance on updated mask recommendations from CDC
The ADA has issued guidance to help dentists answer questions about new recommendations from the Centers for Disease Control and Prevention regarding mask use for fully vaccinated people.
“The recently revised recommendations from the CDC have prompted so many questions from member dentists about what it means for them and their practices,” said Duc “Duke” Ho, D.D.S., chair of the ADA Council on Dental Practice. “The ADA has developed a fact sheet that features anticipated questions from team members and patients, along with appropriate responses to make everyone feel safe at the dental office. This pandemic, as well as the ever changing recommendations, have been difficult to navigate, but we are very aware of the needs of our members and are tirelessly working to provide as much information and guidance as quickly as possible.”
The guidance, posted at ADA.org and called CDC COVID-19 PPE Screening FAQ, answers questions including:
• Do patients still need to wear a mask when visiting a dental office?
• May dental health care personnel stop wearing masks in the breakroom?
• Should dentists continue to screen patients and dental health care personnel?
In regards to the last question, the CDC instructs health care providers to establish a process to ensure everyone entering a health care facility is assessed for symptoms of COVID-19, or exposure to others with suspected or confirmed SARS-CoV-2 infection, and that they are practicing source control.
The recommendations, which were announced May 13, also state, “Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with SARS-CoV-2 infection, symptom screening remains an important strategy to identify those who could have COVID-19, so appropriate precautions can be implemented.”
The ADA guidance lists steps to ensure that everyone adheres to source control measures and hand hygiene practices while in a health care facility, including:
• Posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide instructions (in appropriate languages) about wearing a well-fitting form of source control and how and when to perform hand hygiene.
• Providing supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer with 60-95% alcohol, tissues and no-touch receptacles for disposal at health care facility entrances, waiting rooms, and patient check-ins.
• Limiting and monitoring points of entry to the facility.
• Establishing a process to ensure everyone entering the facility is assessed for symptoms of COVID-19 or exposure to others with suspected or confirmed SARS-CoV-2 infection, and that they are practicing source control.
The ADA reminds dentists that the CDC guidance should be considered in conjunction with any state or local regulations.
How to Heal Post-Vaccine and Counter Effects
Detoxing from vaccines is a process without a definite timeline. Think of it as an ongoing journey. Toxin accumulation, especially heavy metals like mercury, can take a long time to remove from the body. Vaccine toxins can be cumulative, building up with each vaccination, adding to the toxin load we acquire from the enormous amount of environmental toxins we encounter every day.
If you’ve been vaccinated and suffer from serious vaccination damage, you’re best off living a lifestyle that promotes detoxification for the rest of your life. The truth is, you may never be able to dispel all of the toxins that have caused the damage. Living the healthiest possible lifestyle may be your only way to live symptom-free. But then again, to one degree or another, this is true for everyone.
Clearing the vaccine injury with naturopathic and homeopathic remedies is an option. The time between the beginning of the protocol and full recovery is dependent on the severity of the damage, the length of time the damage has been severe, and the amount of suppressive therapy that was administered (pharmaceuticals). All pharmaceuticals will need to be flushed from the body, and the damage they caused must be healed as well.
While some can often recover from a vaccine injury in a matter of weeks or months, detoxifying and repairing the body can take years if the damage is severe (brain damage) or the protocol and diet are not strictly followed, (for example, children who refuse to eat raw vegetables.)
What Damage Is Caused By Vaccines
An individual’s reaction to a vaccine is often similar to how the body would react to the natural disease. In most cases, those most susceptible to vaccine damage are those with a compromised immune system – the same individuals who would suffer the most damage from the natural disease if they contracted it.
Generally, the healthier the individual is prior to the shot, the less severe the reaction. The directions in the package insert (package inserts that provide medical directions to the doctors and information for the patients) specifically say not to vaccinate a sick child. Vaccinating sick children and adults dramatically increases the risk of an adverse reaction.
Minor vaccine damage typically includes fevers, ear infections, sinus infections, diarrhea, and other similar symptoms. This is the body’s attempt to discharge the vaccine matter. Often these reactions are suppressed with antibiotics and other drugs. When antibiotics are given, the gut becomes diseased with fungi and antibiotic resistant pathogenic microbes. Vaccine ingredients alone can still cause diseased intestines due to their powerful antimicrobial nature.“…if you think vaccines are ‘perfectly safe’ or ‘healthy’ you do not understand health…”
Many vaccine ingredients linger in the body, especially the viruses. Vaccines are cocktails of preservatives, pathogens, and adjuvants. Adjuvants are intended to stimulate your immune response to the vaccine-introduced pathogens, and they do stimulate your immune system successfully, but they destroy tissues in the process. Mercury and aluminum are used as adjuvants and preservatives, so this is a case where the treatment for the disease (the vaccine) can be worse than the disease.
Vaccine Detoxification Protocol(s) For Adults
The first step is to eat right. Eating the right kind of foods promotes constant, proper, gentle, healthy detoxification.
Eat to Detoxify
Fruits and vegetables all have some form of detoxification properties. The only problem with fruit is its high sugar content. When someone’s gut is damaged, sugar can promote Candida overgrowth. So, if Candida symptoms exist, fruit should be severely limited and eaten with anti-fungal supplements.
A Gallon a Day
Here’s what you’ll need for cranberry lemonade:
Glass gallon jar
14 cups (almost a gallon) of safe, clean, spring water or distilled water
1 cup of organic cranberry juice, not from concentrate
3 organic fresh lemons – juice them
A citrus juicer
Liquid stevia – to taste
Liquid cayenne – to taste
Most people should drink a gallon a day. Some people cannot due to health issues or due to their smaller size, but regardless, you can drink a lot of it, and it will help flush and cleanse the whole body. There are many benefits to this recipe, but make sure you use healthy, organic ingredients and safe, clean drinking water.
Here is the link for more details:
https://www.theepochtimes.com/how-to-detoxify-and-heal-from-vaccinations_4292712.html?welcomeuser=1
FAQs | Masks + COVID-19 Vaccination
1. CAN FULLY VACCINATED EMPLOYEES IN NON-HEALTHCARE WORKPLACE SETTINGS STOP WEARING MASKS?
Labor law issues involving employer-employee relationships are governed and enforced in Virginia by the Department of Labor and Industry (DOLI), not DPOR. DOLI oversees the Final Permanent Standard (FPS) that addresses occupational exposure to COVID-19.
According to FAQs from DOLI, fully vaccinated non-healthcare employees can safely resume indoor and outdoor workplace duties without wearing a face covering or physically distancing with certain exceptions as noted. See Section 40, FAQ 54.
DPOR is unable to provide guidance or interpretation about how the CDC guidance or Final Permanent Standard affect employers or employees. Any additional questions must be directed to DOLI at https://www.doli.virginia.gov or (804) 371-2327.
2. CAN I ASK EMPLOYEES OR PATRONS TO WEAR MASKS?
Yes.
3. CAN I ASK EMPLOYEES IF THEY ARE VACCINATED?
DPOR is not aware of any Virginia law, regulation, or standard prohibiting employers from asking employees if they have received the COVID-19 vaccine and are fully vaccinated.
The Health Insurance Portability and Accountability Act (HIPAA) applies to healthcare-related “covered entities” and “business associates,” and in most cases does not apply to employers. Accordingly, the patient privacy protections contained in HIPAA do not apply to employers who ask employees if they are vaccinated.
For more information on HIPAA visit: https://www.hhs.gov/hipaa/for-individuals/employers-health-information-workplace/index.html.
4. DO I HAVE TO ASK EMPLOYEES OR PATRONS IF THEY ARE VACCINATED? No. Nothing in the Executive Order states that businesses have to ask employees or patrons if they are vaccinated.
5. CAN I ASK PATRONS IF THEY ARE VACCINATED?
DPOR is not aware of any Virginia law, regulation, or standard prohibiting private businesses from asking patrons if they have received the COVID-19 vaccine and are fully vaccinated.
Regulations of the Board for Barbers and Cosmetology require licensees to take sufficient measures to prevent transmission of communicable or infectious diseases.
The Health Insurance Portability and Accountability Act (HIPAA) applies to healthcare-related “covered entities” and “business associates.” In most cases, the patient privacy protections contained in HIPAA do not apply to private businesses in retail, fitness, personal care, or entertainment sectors asking patrons if they are vaccinated.
For more information on HIPAA visit: https://www.hhs.gov/hipaa/for-individuals/faq/index.html.
6. CAN I REQUIRE EMPLOYEES TO PROVIDE PROOF OF VACCINATION?
DPOR is not aware of any Virginia law, regulation, or standard prohibiting employers from requiring employees to show proof of full COVID-19 vaccination.
The Equal Employment Opportunity Commission (EEOC) indicates that employers may require employees to show proof of full vaccination; however, it cautions that follow-up questions might elicit protected information about a disability.
For more information visit: https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws.
7. CAN I REQUIRE PATRONS TO PROVIDE PROOF OF VACCINATION?
DPOR is not aware of any Virginia law, regulation, or standard prohibiting private businesses from requiring patrons to show proof of full COVID-19 vaccination.
Regulations of the Board for Barbers and Cosmetology require licensees to take sufficient measures to prevent transmission of communicable or infectious diseases.
The Health Insurance Portability and Accountability Act (HIPAA) applies to healthcare-related “covered entities” and “business associates.” In most cases, the patient privacy protections contained in HIPAA do not apply to private businesses in retail, fitness, personal care, or entertainment sectors asking patrons to share vaccination information.
For more information on HIPAA visit: https://www.hhs.gov/hipaa/for-individuals/faq/index.html.
8. CAN I DECLINE SERVICE TO UNMASKED INDIVIDUALS?
Yes. Businesses retain the ability to require masks in their establishments.
| SALE Get each of the 3 models 3m 8200 and 3m 8210 and 3m 9205+ for $2 each. Here is the Link: https://www.msdssafety.com/product/n95-respirator-mask-on-sale-$2-pcWant to change how you receive these emails? You can update your preferences or unsubscribe from this list.   CannonRidge – Linda Cannon is the director. It’s or 501c3 (she is also your Regulatory Compliance Specialist) wants to invite you to come out and run the 5 acres. If you and your children don’t have any place to run, or your children want to come and enjoy the mini Gypsy Horse we have, you are more than welcome. We will only have one family at a time out. But the children can enjoy brushing Sheldon and taking out braids and putting them back. They can take him for a walk. He does help the children and adults with stress. Just Email me at [email protected] or text me at 757-718-1515 (Text Only) and I will put you on the books. There is never a change. I would love for you to support CannonRidge where we bring dental staff members in who are feeling the need for some mindful meditation. Plus abused women and children. Those that are having suicidal thoughts. For any of those who have needed help with the board of dentistry this will be our go to request for payment since there’s not a safety class for the Board of Dentistry! https://therapeuticridingcenter.com For Donations to CRTRC, following are the steps Click Create an account on https://smile.amazon.com  Add details  You will receive a code in email, put this code in below field and click create your amazon account  Since this will be your first visit after creation of account, you will be asked to select charitable organization. Type Cannonridge Therapeutic Riding Center in search bar and click search   It will open the charity organization Select and confirm. Check the box “Yes” and click on start shopping   To Change your Charity if you already have an account and want to select Cannonridge as your charity, Go to Supporting: tap on left side on menu ad click Change It will open the below screen, select Change Charity button  Type Cannonridge Therapeutic Riding Center in search bar and click search  It will open the charity organization Select and confirm.    Organizing your computer for MSDS:Make a folder on your desktop named MSDS.Double click the folder.Create Folders for each category. OSHA-BBP, OSHA Safety Classes, HIPAA, Medical Emergency, BLS-CPR, etc.In each folder, for example, HIPAA:You’ll have the Business Associate Agreement, Patient Consent Form, Office’s Privacy Practice, etc. We love our ClientsMSDS911ADDITIONAL SERVICES OSHA-BBP Exposure Control Plan.Mandatory by Federal OSHA-BBPRequired to be PersonalizedReviewed Annually by all office staff involved in OPIM. (Other Potentially Infectious Materials)This manual is also called: The OSHA manual, The Exposure Control Plan or The Bloodborne Pathogen manual. If you want MSDS to help you with your Personalized manual. The cost for non clients is $450.00. Cost for Clients is $250.00 this gives you not only a personalized manual in binder form, but also in PDF which is the format the Inspectors will want you to have. Best to know that we will not have you answer incorrectly vs. you writing your own manual and the manual is incorrect. MSDS can boast that our manual has never been given anything less than an A+ from an OSHA inspector. Great. App!  |
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