Opening and management of dental practice. Labor and legal ... › ... ›...

Opening and management

of dental practice.

Labor and legal

relationships

Prof. Dr.Krassimira Yaneva, PhD

Plan of the lecture:

1. Requirements for opening of

dental practice

2. Requirements for signing

contract with NHIF

3. Labor and legal relationships

4. Postgraduate education

Options for newly graduated

dentist to work as:

1. Free, private practitioner

2. An employee on a contract – in public

health services, (In Bg there are such

services with Council of Ministers and

Ministry of Defense), hospitals for

treatment of dental diseases, academic

teachers in universities.

Options for private

practitioner to work:

1. In dental surgery, legalized and registered

as a medical treatment facility (own property

or owned by another person).

2. In a surgery, forthcoming for legalization

and registration (building new surgery, or

transforming premises that have a different

status - suit, studio, office).

The opening of a dental office must

comply with the following legal

documents:

1. Medical Treatment Facilities Act

2. Territory Planning Act – 2001

3. Order RD № 09-325 / 04.04.2000 of the Ministry of Health “Hygiene requirements for premises of medical, dental, medical-dental diagnostic and counseling centers, medical diagnostic laboratory and medical technical laboratory, as well as providing anti-epidemic control in them”.

4. Guidline №1 / 21.04.2003г. of the Regional Health Inspection for separate collection, storage and disposal of waste from medical treatment facilities.

5. Act for Health and Safety at Work– 1997.

Sanitary requirements for

dental surgery:

1. Area

2. Walls

3. Floor

4. Exposure

5. Light

6. Fire safety

7. Water supply and sanitation

8. Electrical installation requirements

9. Disinfection and sterilization requirements

10. Requirements for separate waste disposal

11. Requirements for furniture and equipment


dental surgery:

1. Area for: dental office – 12m2; waiting room – 9m2;

rest room – 3m2; dental office with 2 working places -

10m2 each; dental technician workplace – 5m2 etc.

2. Walls – 2.50m height; with X-ray equipment – 3m.

3. Floor – made of material, resistant to moisture and

disinfectants.

4. Exposure – N, N-W, N-E

5. Light – Local/General = 5-10/1


dental surgery:

6. Fire safety - Presence in the office of fire

extinguisher 6 kg; All electrical contacts in the office

to be zeroed; The fridge in the office to be

connected with a separate installation; Presence of

main switch on/off at the exit of the office.

7. Disinfection and sterilization requirements -

presence of autoclave, disinfectants in shelf life.

8. Electrical installation requirements - Economic

use of electricity; Safety and reliability in operation

with electrical appliances; Effectiveness and

durability of use of electrical appliances.


dental surgery:

9. Water supply and sanitation- Presence of sink with

hot and cold water; Water installation of dental unit is

built from PVC pipes with diameter of 15 mm, which

must be placed into the canal under the floor to a

depth of at least 10 cm and secured with PVC pipe;

Under the spittoon there is separator, which retains

the silver amalgam in order not to pollute the soil.

10. Requirements for separate waste disposal – 3

containers for: Hazardous waste (organic waste);

Non-hazardous waste (household waste); Sharp

instruments

Sequence of the procedures for

legalization of premises in a medical

treatment facility:

1. Required documents:

- Notarial deed of the premises,

which will be transformed into a

dentist's office;

- Permission N16 (permission for

use the building);

- A notarized consent of

neighbours.

Sequence in the procedures for

legalization of premises in a medical

treatment facility:

2. Preparing of projects by authorized

architectural company:

- General architectural project design

- Project for heating and ventilation

- Project for water supply and sanitation

- Project for electrical installation


legalization of premises in the medical

treatment facility:

3. Approval of the projects by the Regional Health Inspection for compliance with sanitary and hygiene requirements.

4. Presentation of all documents in the

Municipality to issue of "Permission

for building“.



treatment facility:

5. After completion of building works -

application to Regional Health Inspection

(RHI) for approval the implementation of

the project, i.e. comparison of project to

execution.



treatment facility:

6. Two expert committees from RHI check the working conditions in the new cabinet:

6.1. Directorate “Laboratory Control”:

- Protocol for lighting

- Protocol for physical parameters of the

environment – t°, humidity etc.

- Protocol for noise

6.2. Directorate “Epidemic Control”:

- Disinfection

- Sterilization

- Separate elimination of the waste



treatment facility:

7. Positive opinions from the Expert

Committees, together with a report by an

authorized company for building supervision

are given to the municipality with a request for

registration of the premises in the

cadastre of the settlement as a medical

treatment facility. The deadline for a

response from the municipality (Chief

Architect) is 1 week.



treatment facility:

The municipality permit, together with the

positive certificates of expert committees of

RHI are submitted in RHI where is issued

THE SANITARY PERMIT OF THE

MEDICAL TREATMENT FACILITY

The Sanitary Permit certifies that treatment

and diagnostic procedures can be

performed in this room.

The dentist could be registered in

Regional Health Inspection (RHI):

1. As a freelancer – individual practices

for primary and specialized dental care.

2. As a sole trader (ST) or a limited

liability company (Ltd) – (registered under

the Commercial Law) –group practices,

practices for outpatient specialized care,

hospices.

Required documents when

registering a dentist as a freelancer:

1. Diploma for completed education in Dental Medicine

2. Diploma for acquired dental specialty (if any)

3. Criminal Records Certificate

4. Certificate of membership in the BgDA

5. Sanitary Permit of the surgery

Required documents when registering the

dentist as a ST or Ltd:

1. Court decision for registration.

2 . Tax registration certificate.

3 . Unique identification code.

4 . Rules for the structure, activity and internal order of the medical

facility.

5 . Copies of diplomas of the dentists who will work in medical

facility- for higher education and specialty.

6 . Certificates from BgDA for membership of persons who will

work in medical facility .

7 . Criminal record certificates of employees.

8 . Hygienic conclusion of the dental office from RHI .

9. Permit from the competent authorities for the use of X-ray

equipment.

After the registration in RHI,

within 1-week should be done:

1. Registration in the National Insurance

Institute – Bulstat number

2. Registration in Tax Administration:

- Tax number for registered under the

commercial law;

- Identification number (EGN – Public

Registry Number) - for working as

a freelancer.

Work in contract with National

Health Insurance Fund (NHIF):

1. Who is entitled to contract with the

NHIF?

2. What documents are required?

3. What is the contract period?

4. Contract signing procedures

5. Obligations of the parties in the

contract - the doctor and NHIF.

Who is entitled to contract

with NHIF:

1. Individual practices for primary care;

2. Group practices for primary care;

3. Individual and group practices of specialists in “Oral Surgery";

4. Individual and group practices of specialists in "Pediatric Dentistry";

5. Dental centers, offering primary care;

6. Medical-dental centers, which employ specialists in “Oral Surgery" and / or "Pediatric Dentistry".

Required documents for signing the

contract with Regional Health

Insurance Fund:

1. Application form

2. Certificate of current membership in BgDA

3. Certificate of registration in RHI

4. Declaration that there is the required technical

and dental equipment

5. Bulstat Registration

6. Bank account for the remuneration from the

fund.

The contract with RHIF:

1. Shall be signed within 1 month after

submission of required documents.

2. Is active 1 year (until the signing a new

Framework Agreement or change of the

currant);

National Framework Agreement

1. National Framework Agreement (NFA) is

a contract between the NHIF and

professional organizations of doctors and

dentists.

2. It describes medical activities that are

paid in whole or in part by the fund.

3. Outpatient dental activities are organized

in a packages of services for primary and

specialized dental care for persons up to the

age of 18 and over 18.

Control over contractors:

The Regional Health Insurance Funds exercise control over contractors:

1. Medical control on: observing the rules of good medical practice, the type and amount of services, the type and quantity of prescribed drugs, documents of temporary disability etc.

2. Financial control on: a financial performance of the contract and record keeping.

Termination of the

contract with the NHIF:

1. Upon expiration of the contract, modification or adoption of new NFA.

2. Upon deletion of office registration in the

Regional Health Inspection.

3. By mutual agreement of the parties with notice:

- 3 months in advance for the primary

health care;

- 1 month - for specialized health care.

Hiring and dismissal of supporting staff:

1. Hiring under a contract of employment: The employment contract contains: hours of work, duration

of working day and working week, amount of paid annual

leave. Employees employed under a contract of employment

are compulsorily insured for all social risks.

2. Hiring under a civil contract: In the civil contract,

the contractor himself determines his working time and

place, as well as the length of the working day. Persons who

have a civil contract do not have paid annual leave and are

not entitled to temporary disability benefits by the National

Social Security Institute, since no deductions are made for

the sickness and maternity fund.

3. Dismissal with a prior notice: The notice period

for termination of employment is between 30 days and 3

months

Postgraduate education:

1. Continuous education (development,

qualification)

2. Specialization: The training for

acquiring a specialty in the healthcare

system is carried out in accordance with

the terms and conditions of Ordinance

No. 1 / January 22, 2015. of the Ministry

of Health.

Continuing education:

1. BgDA program for PGE. Since 2005 the

BgDA has introduced a program of PGE

with free of charge lectures, performed by

leading Bulgarian and foreign lecturers.

2. Lectures and courses led by local and

foreign specialists.

3. Congresses, symposia, conferences.

4. Monographs, textbooks, articles,

newspapers, magazines etc. The purpose of continuing education is to maintain the knowledge and

skills of dental practitioners at advanced level!

Specialization in dental

medicine

The specialization in dental medicine is

carried out through 3-4 year programs

with theoretical and practical training in a

particular field of dental science.

Theoretical training is provided by the

dental faculties, and the practical training

is carried out in medical facilities

accredited for training in a specialty.

Dental specialities in Bg:

I. Clinical specialities:

- Dental Implantology

- Dental Clinical Alergology

- Pediatric Dentistry

- General Dentistry

- Conservative dentistry

- Oral Surgery

- Orthodontics

- Periodontology

- Prosthetic Dentistry

- Dental Radiology

Dental specialities in Bg:

II. Non-clinical specialities:

- Biochemistry

- Social Medicine and Dental Public Health

III. Specialities for persons with

degrees “Master in Medicine” and

“Master in Dental Medicine”

- Maxillo-Facial Surgery

Procedure to determine the type

and number of specializations:

(according to Ordinance N 1/22.01.2015)

1. Until 15 June – RHI give their proposals about

the need of specialists to the Minister of Health.

2. By September 1st the dental faculties send to the

Minister of Health information about the graduates

with the “Golden Hippocrates”, “Golden Hermes

with caduceus” and “Golden Galen” awards who

have the right to choose a specialization at will.

3. Until 30 October – the Minister of Health

determines the specializations, that the state will

fund.



4. From 1st to 31 of November - the candidates submit

their applications in the universities.

5. Until 31 of December - the selected candidates are

ranked and published on the website.

6. In 7 days the school sends the data of the selected

candidates to the Ministry of Health.

7. Specialization and its financing start from January 1st

next year.

8. After expiry of specialization and fulfilling the

necessary requirements a trainee takes a state exam in

the specialty. After successful taking the examination the

trainee receives a certificate of specialty.

.



8. When ranking for specialization, funded by

the state, the contract between a successful

candidate, University and the Ministry of

Health is signed.

9. When ranking for specialization for fee the contract between a successful candidate

and University is signed.

I wish you a green light in

your future profession!!!

Opening and management of dental practice. Labor and legal ... › ... ›...

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