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On Thursday, September 9th, a COVID-19 vaccine mandate was announced for federal workers and government contract workers. In addition to the federal worker rules, there have been several other directives out of U.S Health and Human Services (HHS) and the Labor Department that will impact pediatric dental practice.
Under the new rules from HHS, the Centers for Medicare and Medicaid Services (CMS) will be requiring the vaccine for workers employed by Medicare and Medicaid-certified healthcare organizations. Our understanding is that this does NOT apply to private practice dentists who participate in Medicaid; we are awaiting guidance from CMS to confirm this point. Further, the Occupational Safety and Health Administration (OSHA) will be requiring businesses with over 100 workers - including educators and school staff – to get vaccinated with a COVID-19 vaccine or be tested weekly for SARS-CoV-2.
While the great majority of dentists are already fully vaccinated (89.8% as of June 2021 according to the American Dental Association), please note that state mandates for health care workers may be broader than the federal vaccine mandate. The AAPD concurs with the ADA that dental professionals are strongly encouraged to be vaccinated, but that vaccinations should not be mandated.
Check out these selected resources to keep up to date on the new mandates and more:
Vaccine Mandates by State: Who is, Who isn't, and How?
Tracking COVID-19 Vaccination Among Dentists
Guidance for Documenting Employee COVID-19 Vaccinations (ADA login required)
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The U.S. Health and Human Services (HHS) has announced the availability of 25.5 billion dollars of additional Provider Relief Funds (PRF) for health care providers for lost revenue and costs related to the COVID-19 pandemic. Phase 4 payments to providers, including a bonus payment to those serving Medicaid/CHIP and Medicare patients, are based on the losses and expenditures between July 1, 2020, and March 31, 2021. Additional funds are available through the American Rescue Plan (ARP) for providers serving rural patients on Medicaid/CHIP and Medicare, and these funds can be applied for on the same application. The application opens on September 29th.
HHS has also announced that there will be a 60 day reporting grace period for period 1 reporting for providers impacted by recent disasters. To read the the Phase 4 Provider Relief Funds announcement from HHS, click here. Click here to visit the Provider Relief Fund Application and Attestation Portal, and here to access the PRF Reporting Portal.
The American Dental Association created a detailed FAQ to help guide dentists through the phase 4 funding process. The resource includes information on eligibility, application and reporting processes, but also explains what to do if your 3rd payment was calculated incorrectly, provides a list of expenses and revenues lost that qualify for reimbursement, addresses a common tax-related question, and more. Click here to view Frequently Asked Questions: HHS Provider Relief Fund.
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The Urban Institute reports that as of April 2021 many parents are delaying bringing their children to medical and dental appointments because of worries that their child(ren) may be exposed to COVID-19. Dental appointments topped the list with 5.3% of parents reporting they hadn’t brought their child in for appointments that they would have in normal circumstances. Parents in low-income households were more likely than higher income households to delay or avoid scheduling. The authors suggest that scheduling may pick up once children under the age of 12 become eligible for the vaccine and recommend an across-the-board effort by government, payers and providers to help children make up postponed care.
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This motto led the AAPD through the first waves of the COVID-19 pandemic and our initial uncertainty. Many things have changed since March 2020, but the guiding principles that emerged early on remain a top priority. The motto holds true in August 2021 – and beyond. While we are reassured by the low levels of transmission in dental practices, we must continue to stay on top of local infection rates and local directives, while maintaining safe and accessible care.
Schools will be resuming in-person learning this fall, the timing of which may coincide with the current rise of infection rates in some parts of the country. Patients younger than 12 years old in school will experience varying degrees of exposure to SARS-CoV-2, depending on local cases, policies and vaccine eligibility. Pediatric dentists should continue to be aware of and adhere to the evolving screening, testing, masking and vaccine recommendations from governmental and professional organizations. Check out these resources for the latest trends and guidance - and come back frequently for ongoing updates!
COVID-19 Data Tracker
Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination -
Update to Office Procedures During COVID-19 corresponds to the key reference from the American Dental Association (ADA), Return to Work Interim Guidance Toolkit., adding to it a number of new considerations from hazard assessment and staff protection to screening protocols following the recent release of new and revised infection control recommendations and requirements, such as OSHA’s Emergency Temporary Standard for Healthcare Settings and Guidance for Dental Settings: Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. This short checklist of considerations makes practice during the pandemic a little bit easier and it will surely be another indispensable part of your COVID-19 toolkit. Click here to read Update to Office Procedures During COVID-19.
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Guidance for Dental Settings, a key infection control resource for dentists practicing during the COVID-19 pandemic, has been updated to reflect the current understanding of the risks involved with COVID-19 transmission and aerosol-generating procedures. The CDC removed the recommendation for all patients to avoid aerosol-generating procedures following the observation that, to date, dentistry has demonstrated a high level of safety for patients and clinicians. The guidance still advises that dentists avoid aerosol-generating procedures for patients with suspected or confirmed SARS-CoV-2 infection. Click here to view the updated Summary of CDC COVID-19 Guidance for Dental Settings.
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Patients experiencing lingering symptoms for four months or longer after initial infection or symptom presentation fall into a category called post-covid conditions, otherwise known commonly as "long COVID" and "COVID long haulers", or clinically as post-acute sequalae of SARS-COV-2 infection (PASC). Unfortunately, the specter of long-term health consequences from coronavirus can be as haunting to children as to adults. Top symptoms for children experiencing post-Covid conditions include gastrointestinal issues, chest pain, headaches, fatigue, joint/muscle pain/weakness, sore throat, dizziness, rashes, mood changes and nausea.
The NIH has undertaken a research initiative called RECOVER to understand PASC and aid in the recovery of those who are impacted longer term because of infection with the virus. Clinicians who would like more information this topic can look to these two excellent resources from the Centers for Disease Control and Prevention: Post-COVID Conditions: Information for Healthcare Providers and Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance.
AAPD COVID-19 Resources
AAPD has provided additional resources regarding infection control, practice and staff management, emergency care, office closures/limited services and COVID-19 status.