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What is a 1031 Exchange and How Can It Benefit You?

Definitions and Tax Rules

To understand what a 1031 Exchange is, it is crucial to understand where the name originates from, as well as, the tax definitions and rules supporting the exchange. According to the Internal Revenue Service (“IRS”), the Internal Revenue Code (IRC) Section 1031 provides an exception for taxpayers who have sold a property at a gain. This tax rule is intended for use on investment or business properties. The 1031 tax break exchange is only allowable to personal residences after certain circumstances are met. Primary residences typically have other allowable tax breaks on capital gains taxes.  After the sale of an asset (a property in this case) a taxpayer would normally be required to pay capital gains taxes on the sale. Capital Gains Taxes are the taxes owed from the profit of a sale of assets. If an asset is held for less than a year after it is purchased and is then sold at a profit, those gains are typically added to the taxpayer’s income. But if an asset is held for over a year, the ‘Long Term Capital Gains” tax rate is applicable. The percentage of capital gains owed per sale is dependent on the tax bracket of the taxpayer. The current rates range from 0% to 20% depending on income.

IRC Section 1031 allows taxpayers to postpone paying capital gains taxes on the sale of a real estate property by allowing taxpayers to roll over the taxes on the gain if the proceeds are reinvested in a similar property as part of a “Like-Kind Exchange”. A Like-Kind Exchange is an exchange of real estate property that is of similar nature that can be traded without incurring tax liabilities. The Internal Revenue’s rules around Like-Kind properties of similar nature are very liberal. The properties in the exchange do not need to be the same type of property. The only pertinent rule is that the properties be used for business or investment purposes. Personal residences are not eligible to be qualified as like-kind properties and can only benefit from Section 1031 when they meet specific requirements. Properties taking part in a 1031 exhange must also be held in the United States to qualify.

 

What Is A 1031 Exchange?

In layman’s terms, a 1031 exchange is a tax break. It allows for investors to swap investment properties without having to pay taxes at the time of exchange. It grants taxpayers the ability to grow their investment without having to pay capital gains taxes until an investment is liquidated or sold for cash. There is no limit to how frequently taxpayers are able to take part in 1031 exchanges. Taxpayers can defer these capital gains taxes and rollover the gains for years.

Key Timeline Regulations Of A 1031 Exchange

Most 1031 exchanges are delayed exchanges. Typically, property owners are not able to find a property to exchange at the moment of a sale. There are rules established to define delayed exchanges. Two key rules must be observed for every delayed exchange. The 45 Day Rule states that within 45 days of the sale of a property, a replacement property must be designated in writing to an intermediary. A Qualified Intermediary , sometimes referred to as an ‘exchange facilitator” or an “exchange accommodator”, must be appointed to hold the gains after the sale of a property for the sale to be recognized as a 1031 exchange. The intermediary is usually appointed by the seller and acts as a third party to hold funds and can also coordinate transfers, assist with paperwork, and support investors. There are no definitive rules on who can act as an intermediary. There are, however, rules on disqualifications for intermediaries. An intermediary must be neutral and not be directly related to any of the parties involved. Disqualified parties include family members, friends, anyone who has acted as an agent for the parties, tax preparers, etc. Investors are allowed to designate up to three properties to the intermediary as long as one of the properties is eventually closed on. The 180 Day Rule states that a property must be closed on within 180 days of the sale of the old property. Both the 45-day rule as well as the 180-day rule run simultaneously. This means that the clock begins to move for both of these rules once the sale of the property closes.

What Are The Pros And Cons of A 1031 Exchange?

Typically, if an investor is looking to purchase a new property soon after the sale of a property, a 1031 exchange is recommended. There are many reasons why an investor would be looking to carry out a 1031 exchange. The obvious pro is deferring capital gains taxes on the sale of a property. A 1031 exchange also allows for investors who are interested in moving to a new market to move seamlessly. There are no distance limitations for a 1031 exchange. There are also no limits to how often you can take part in a 1031 exchange. This means that an investor can sell a property anywhere in the United States and use the money from that sale to purchase another similar property anywhere else in the United States. It gives investors the opportunity to switch markets without having to pay major taxes.

There are, however, some cons to keep in mind. In order to move forward with a 1031 exchange, the capital gains earned on the sale of a property must be rolled over to a ‘like-kind’ investment. Should an investor want to use the gains for any other type of investment or purchase, they would lose the protection of the 1031 exchange and be required to pay the applicable taxes. Another con is that the structure can become complicated if there are multiple investors in a property and they are not all in agreement. It is possible to complete a 1031 exchange if not all of the investors of a property agree to rollover the gains. The remaining funds would be placed into a separate account and be liquidated. This circumstance is not common and is more complex.

Overall, a 1031 exchange is a great tool for investors. The Internal Revenue Service allows for investors to get a tax break and roll over their tax liabilities on the capital gains taxes potentially forever. It is a great way for investors to maximize their opportunities and build generational wealth.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

 

 

Florida Telehealth Licensing Outlook

Generally, telehealth providers must be licensed within the state where the patient resides or is receiving care. In response to the COVID-19 pandemic, nearly every state issued temporary waivers to medical professionals licensed in other U.S. states, which allowed providers to offer telehealth services to patients across state lines without the need to obtain licensing from the particular state in which the patient resided or received care. To combat the pandemic and expand telehealth services within the state, the Florida Department of Health issued an emergency order on March 16, 2020, which permitted medical professionals unlicensed in Florida to provide healthcare services to Florida residents affected by the coronavirus. Florida’s telehealth emergency waivers ended on June 26, 2021, after Governor Ron DeSantis decided to let the waivers expire.

Now, other states are also gradually rolling back these telehealth emergency waivers afforded to out-of-state healthcare providers during the early stages of the pandemic in favor of more permanent changes to regulate interstate telehealth delivery. In particular, Florida has been a first mover in establishing a permanent registration telehealth policy. During the 2019 legislative session, Florida lawmakers passed section 456.47, Florida Statutes, which authorized out-of-state healthcare providers to furnish telehealth services to patients residing in Florida and established standards of practice for telehealth services. After Governor DeSantis signed the law on June 25, 2019, the law took effect on July 1, 2019. Under section 456.47, all out-of-state healthcare providers are required to register with the Florida Department of Health in order to furnish telehealth services and may not provide in-person services to Florida patients.

More recently, Governor DeSantis signed a new law amending Chapter 456.47 to remove prior restrictions on the prescription of controlled substances via telehealth on April 6, 2022. Under the new law, telehealth providers may prescribe Florida patients all controlled substances except for Schedule II substances. While this amendment does permit out-of-state healthcare providers to prescribe controlled substances to Florida patients via telehealth, providers should also be aware of federal law that also governs the prescription of controlled substances. Under the Ryan Haight Online Pharmacy Consumer Protection Act, a controlled substance may not be prescribed by means of the internet without a valid prescription. Providers are required to conduct at least one in-person medical examination of a patient before prescribing a controlled substance to patients. The Ryan Haight Act law does provide seven exceptions to the in-person requirement, but these exceptions are narrow and apply only to providers in an institutional setting.

Another approach to telehealth licensing that has started to gain traction involves the adoption of an interstate compact, such as the Interstate Medical Licensure Compact. The compact was created to allow medical professionals an expedited alternative to obtain additional state medical licensure to qualify to practice medicine among IMLC member states. To date, the IMLC is composed of 33 states, the District of Colombia, and Guam. Other states such as Massachusetts, New York, and North Carolina have passed legislation to be admitted to the IMLC. Under the current administration, Florida is unlikely to join the IMLC as admission to the compact would require the Florida Legislature to overhaul the state’s health care policy and pass new stand-alone bills which would be a significant commitment.

Looking forward to 2023, two key issues to keep an eye out for includes potential legislation surrounding telehealth payment parity and the increase of telehealth fraud.

Payment Parity

In April 2022, the Federation of State Medical Boards (FSMB) released an updated telemedicine policy for the first time since 2014. The FSMB acknowledged that rapid growth and utilization of telemedicine technologies have dramatically transformed conventional healthcare delivery. As such, the FMSB intends to advise state medical boards on proper procedures to regulate the use of telemedicine technologies in medical practice for the benefit of the public. The FMSB observed that limiting insurance coverage for healthcare services delivered via telehealth may increase inequities in the access to healthcare. The FMSB recommends that health insurance plans should provide the same coverage extended for the cost of healthcare services delivered in-person on the same basis as those delivered through telemedicine.

Who Can Sign off on a Death Certificate in Florida?

Death Certificates: Definitions, Requirements, and Purpose

What Is A Death Certificate?

By definition, a death certificate is an official government issued document that declares the known data of a deceased person at their time of death. A death certificate is a legal record of death. This can include but is not limited to, the identifying statistics of the decedent along with the specific information of the death in question such as the time of death, exact location of death, and cause of death.

What Information Should Be Reported On A Death Certificate?

Other than the identifying information of the deceased individual, there are common details that should always be listed on a death certificate. At a minimum, death certificates should include the following information:

  • Probable Manner of Death: The statement on the manner of death should be as specific as possible. For example, the manner of death should not be listed as “natural causes”, but rather a list of illnesses likely to have prompted the mortality of the decedent.
  • Time of Death: The time of death must be written in the standard 24-hour universal time clock.
  • Known or Significant Conditions: This can include identified underlying illness or diseases that conceivably lead to the death; it can also include smoking habits or drug use.

Who Can Sign Off On A Death Certificate?

According to the Florida Statutes (FS § 382.008), the death certificate is to be signed within 72 hours by the appropriate party. The typical certifier of the death certificate is the medical practitioner in charge of the decedent’s care for the illness or disorder which resulted in the death of the decedent. The death certificate may also be signed by the medical physician that was attending to the decedent at the time of death or immediately after death. In the instance of a natural death, it is expected that the medical practitioner that was caring for the decedent (withing the previous 3 months) will sign the death certificate. At times there will be no specific illness or conditional circumstances which resulted in the death of the decedent. The signing medical practitioner or medical examiner will declare the cause of death to the best of his or her knowledge and belief. It is common to use terminology such as “probable” and “likely” for a decedent whose cause of death is not certain. It is up to the medical practitioner to use their best medical opinion at the time of signing the death certificate.

Should the case be deemed a suicide, a homicide, or an accident it is not unlikely for a medical examiner to certify the Death Certificate. Any case that is under investigation or indeterminate will fall under the responsibility of the assigned medical examiner to certify and complete.

It is required that the funeral director file the death certificate within 5 days. There is also a 5-day extension period if the funeral director needs additional time to meet with family to certify information requested. Should any supplementary evidence be discovered after the death certificate has been certified and filed, it is possible to have the death certificate amended.

The Bureau of Vital Statistics along with the Florida Association of Medical Examiners combined efforts and have created a tutorial on completing a Death Certificate. Should any medical professional be interested in viewing, it can be found at:

https://register.gotowebinar.com/recording/3534793941604824833

What Is The Purpose Of A Death Certificate?

There are many instances where a death certificate is useful, and even necessary. The Department of Public Health keeps records of death certificates and can create reports detailing leading causes of death and produce reports for public or private knowledge on information such as: suicide and homicide related deaths, infant death rates, occupational related death, etc.

The death certificate is also necessary for the decedent’s family, or next of kin, to have for a variety of legal purposes. Should a probate case need to be opened, a death certificate is necessary. A death certificate is also needed for a family member to claim any potential veteran’s benefits, social security benefits, or life insurance. Financial institutions such as banks, vehicle loan holders, credit card claims, etc. will also require a death certificate to process any requested information for the next of kin.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

 

Washington D.C. Amends its Ban on Non-Compete Agreements

What is a Non-Compete Agreement or Provision?

A Non-Compete provision may prohibit current and former employees from simultaneously or subsequently being employed by another entity or operating their own business within a certain geographic radius for a defined period of time (i.e. 2 years) if the employee will provide similar services in a competing field of work. This provision is typically presented to employees upon an employment offer as a part of an employment agreement.

A Non-Compete Agreement is a standalone agreement between an employer and employee that has one or more Non-Compete provisions or restrictive covenants. An agreement can also be entered into after employment has begun but should be provided at least 14 days prior to taking affect. Employers require employees to sign a Non-Compete to limit competition, conflicts, and improve quality of work.

Original Ban on Non-Compete Agreements

On January 11, 2021, the District of Columbia signed D.C. Act 23-563, which banned Non-Compete provisions in employment contracts protecting employees from being required to sign a non-complete agreement as a condition of their employment. This act prohibits employers from presenting Non-Compete agreements and opens the door for employees to “moonlight”, seek additional employment, or pursue other professional endeavors since they would no longer be restricted to a single employer.

The Purpose of the Clarification Amendments

D.C.’s ban was one of the broadest bans on Non-Compete provisions. Employees were free to simultaneously work two jobs with no wage threshold. Only medical professionals were prohibited from simultaneously working for two employers. The original Act was immediately subject to criticism and has had various delays to its applicability date due to its controversy and vague (if any) limitations in most areas.

What Are the Clarifying Amendments?

One of the most notable changes in the provisions specifies which employees are subject to the Non-Compete ban.  The original Act broadly stated that “individuals performing work in the District for an employer” were protected from Non-Competes. However, the clarifying amendments set salary thresholds. The amendments stated that highly compensated employees are exempt from the protection of the Ban. According to the amendment, ‘highly compensated employees’ are “employees who are reasonably expected to earn from the employer in a consecutive 12-month period compensation greater than or equal to the minimum qualifying annual compensation.” The minimum qualifying annual compensation is $150,000, or $250,000 if the employee is a medical specialist. A medical specialist is considered someone who holds a license to practice medicine and has completed residency. The annual compensation is suggested as the amount equal to the previous calendar year’s annual compensation increased by the annual average for inflation coverage.

The amendment to the Act also clarifies that employees are prohibited from using confidential employer information elsewhere. Employees are prohibited from ‘“[d]isclosing, using, selling, or accessing the employer’s confidential employer information or proprietary employer information” to the benefit of third-parties. There was a similar carve out in the original Act and other protections that prohibited employees from using any confidential information but the amendment clarifies and reinforces the definition. Employers can impose a Non-Compete if they reasonably believe that moonlighting will result in disclosure of confidential information, will cause a conflict of interest, or a conflict of commitment to the work at hand. This provision is controversial because it allows employers to prohibit their employees from seeking additional employment if the employer determines that there is a conflict of interest.

Limitations for Employers

Non-Compete Agreements are only enforceable if they contain certain limitations. The amendment clarifies qualifications for an employer/employee relationship covered under the Act. It states that a D.C. employee is someone who is working at least 50% of the time for their employer in the District. Applicable Non-Compete Agreements are not valid for more than 365 days, there must be a 30-day notice and a written agreement at least 14 days prior to commencement. The agreement must also include the scope of employment and geographical limitations.

Overall while a bit controversial, the Act harmonizes the coverage for employers as well as protections for employees of D.C. It is consistent with other D.C. laws. The clarification was finalized on July 12, 2022 but became effective on October 1, 2022.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

What are the Differences between a Rural Health Care Clinic and a Federally Qualified Health Center?

What is a Rural Health Clinic?

A Rural Health Care Clinic (RHC) is a clinic designed to provide quality care to patients in rural areas. They are Medicare certified programs that must be established in areas designated as rural shortage areas. An RHC is not permitted to care for patients of mental diseases or rehabilitation services. At least fifty percent of the time the clinic is open there must be a nurse practitioner, midwife, or physician assistant to provide care to patients. These medical professionals are under direction of a physician. RHCs are required to staff personnel, but there are no requirements to maintain a Board of Directors. Two types of Rural Health Clinics exist: (1) an Independent Rural Health Clinic which is a freestanding clinic not associated with a hospital or any type of Health Care Agency; and (2) a Provider Based Rural Health Clinic which is the subordinate of a hospital, home health agency or nursing facility. Also, Rural Health Clinics do not receive federal funding for start-up or expansion.

Licensing and Certification Requirements

RHCs must apply for certification with Medicare. All mandatory applications and requested documents must be submitted along with a survey. To be considered a “rural area” the Census Bureau designates non urbanized areas as rural areas during annual surveys. This is a separate designation that can only be assigned by the Census Bureau.

What is an FQHC?

A Federally Qualified Health Center are primary care outpatient centers that serve underserved communities. FQHCs qualify for reimbursements from the Health Resources and Services Administration (HRSA), Medicaid, and Medicare. An FQHC can receive government grants, donations, and private sectors in addition to the Medicaid reimbursements. To be considered a Federally Qualified Health Center a clinic must meet certain requirements including: (1) serving an underserved area; (2) provide care on a ‘sliding fee scale’ which is based on ability to pay; (3) complete required annual reports; (4) provide holistic and social services; (5) and not be approved as a rural health clinic.

What are the similarities?

Both programs are established to provide quality health care to underserved and community shortage areas. Similarly, they are capable of providing care to Medicaid and Medicare patients. They are both government established programs that were created to aid in the creation of facilities in the medically underserved areas. Because of this they can both be classified as profit or not for profit organizations. They are also equally subject to survey and review.

What are the differences?

Rural Health Clinics are only located in rural areas designated as shortage areas whereas Federally Qualified Health Centers can operate both in rural and nonrural areas with medical shortages. RHCs cannot treat mental illnesses or provide rehabilitation services. RHCs exclusively operate to serve Medicaid patients’ primary care and dental needs in rural shortage areas. FQHC’s qualify for reimbursements from Medicaid and Medicare and are required to provide care for patients in all life cycles (with the exception of pediatric clinicians). FQHCs also provide a broader scope of care for patient needs. FQHC’s are also required to provide some form of after-hours care unlike RHCs. FQHCs are expected to have hospital admitting privileges or an established hospital coverage plan to ensure continuity of care. Another difference is that RHC’s do not have requirements to serve anyone in the community while FQHC’s are required to provide care for all community residents.

From an outside perspective, both types of clinics seem very similar. While both are established to provide care for medically underserved populations (MUPS), there are many differences in requirements, staffing, type of care, and funding to take note of.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Do Doctors and Nurses Have to Self-Report to the Florida Department of Health if Arrested?

In our society, Medical Professionals have always been held to a higher-than-average standard. Doctors, nurses, and physicians must abide by several professional rules of conduct that not many other employees have to keep in mind. This in turn also means that your personal life is up for scrutiny as well. Ethical standards and moral values are usually private assumptions but for those who have chosen the medical field, those normally private matters can have a deep affect your employment status. Any serious off-duty conduct issue must be reported, reviewed, and taken care of on a case-by-case basis.

Florida Requirements for Self-Reporting

In Florida, doctors are required to report all criminal activities committed after they receive their medical license even though it is not in relation to employment and occurs after regular working hours. Any report or complaint filed towards a medical professional will be investigated by the Florida Department of Health. Being placed under arrest can trigger disciplinary action from the state licensing boards. Medical disciplinary actions require a much lower burden of proof than federal cases. It is possible to be penalized, face Medicare/Medicaid exclusion, and potentially have your license revoked based on the severity of the crime and investigation. It is entirely possible that a physician can face the loss of their medical license even if an investigation does not result in criminal prosecution and a conviction at a trial.

Complaints Against Medical Professionals

The most common criminal concerns leading to the harshest disciplinary actions towards a medical professional involve healthcare fraud, solicitation, moral turpitude, dishonesty, or deceit in any jurisdiction in the state. According to the Florida Department of Health’s website, they do not carry out complaints regarding the fees charged for individual procedures, missed, or cancelled appointments, unfair customer service, rudeness or disrespect, bedside manner, professionalism or personality conflicts again medical professionals.

Complaints against medical professionals can lead the Board of Medicine to issue citations based on the type of and severity of the complaint. It is completely free to file complaints against medical professionals. The only potential fees may be for requesting copies of medical records if deemed necessary. Complaints remain confidential until the panel determines reasonable cause, and a violation is issued.

How to Report

According to the Florida Board of medicine, all criminal activities after receiving your medical license must be timely reported. The Board provides various options for reporting including email, online service portal, or via regular mail. If a complaint is issued via sending an email or letter, the correspondence must include the date of the offense, the activity that happened, and the county and state of jurisdiction. The complaint cannot reach processing without the proper information.

The Florida Department of Health’s Medical Quality Assurance (MQA) launched a user-friendly online portal. The portal was developed in collaboration with the Agency for Health Care Administration (AHCA) to allow for easy reporting of any complaints again medical providers from fraud to unlicensed activity and violations. The portal offers education on the different federal agencies for complaints as well.

See below for email, website and address:

MQAOnlineService@FLHealth.Gov
www.mqa-vo.doh.state.fl.us./datamart/voservicesportal
Florida Department of Health

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Do I Need A Permit to Utilize Sedation Dentistry in Florida?

What is Sedation Dentistry?

Sedation Dentistry is a mild to moderate level of sedation used to assist dental patients with attaining a temporary insensitivity to pain while remaining conscious. Typically, this is used for lengthier procedures and is also found to be very beneficial for patients that suffer from anxiety about having dental work done.

What are the different types of Sedation Used?

There are a few different types of sedation that can be used for dental procedures. The kind of sedation used depends on the treatment or procedure at hand and the level of anxiety the patient suffers from. There are also varying factors such as the patient’s weight and medical history.

Oral Sedation: With oral sedation, a pill is administered about one hour before a procedure so it has time to take effect. Usually, patients will feel tired and dazed. This is considered “minimal sedation”. It is possible to fall asleep while under oral sedation but not common. At most, it would be a light sleep and the patient can be easily awakened. This type of sedation is ideal for patients with fear or anxiety. It will affect memory and motor skills and, accordingly, patients must be advised against driving themselves home.

Inhalation Sedation: This is typically known as “laughing gas”. Nitrous Oxide is administered through a mask or nosepiece. It is a gas and the dosage is controlled by the dentist and begins to take effect almost instantly (within 3 to 5 minutes). This method merely calms the patient to sit through the procedure and may provide mild pain relief. Oral injections can be provided simultaneously with nitrous oxide. Once finished, oxygen is passed through the mask or nosepiece and the nitrous oxide is flushed out of the system. This is also considered “minimal sedation”.

Intravenous Sedation: Sedative Medications are pumped into the veins of a patient and through the bloodstream. This requires the monitoring of blood pressure, oxygen levels, and heart rate and is the most intense form of sedation allowed to be used in a dental office. This is considered “moderate sedation”. Patients typically fall asleep and have no memory of the procedure afterwards. It is not recommended to operate a motor vehicle after intravenous sedation. Patients should be advised to not eat or drink for 6 hours before having intravenous sedation.

General anesthesia can be used in a hospital or ambulatory setting. It is an unconscious sedation, and an anesthesiologist must be present. This is not very common for a dental procedure and cannot be performed in dental office.

When is Sedation Used in Dentistry?

Sedation is usually offered to patients who have some sort of anxiety about a procedure. It is also offered to minimize the amount of pain felt during a procedure. For lengthier or more painful procedures such as root canals, it is always recommended.

Who Can Utilize Sedation Dentistry?

The Florida Board of Dentistry allows dentists to administer a small dose of oral sedation without having advanced training or permitting. A single dose of a medicine is allowed up to the maximum dosage per patient weight. Dentists are also allowed to supplement with nitrous oxide. This is considered “minimal sedation”. Formal advanced training in sedation is required to administer “moderate sedation”. This is done through an internship or an approved course. Dental professionals must complete 60 hours of didactic instruction on a minimum of 20 patients, and an inspection of the office must be performed including a demonstration of an emergency drill before any permit is issued with the Board of Dentistry. To administer “deep sedation” or general anesthesia, a dentist must complete a residency in General Anesthesia an receive a permit from the Board of Dentistry. Pediatric sedation requires a completely separate permit and training requirements.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Do I Need a Biomedical Waste Permit for my Clinic?

Biomedical Waste Permit Regulations

Biomedical waste is the inevitable outcome in most health care offices. Professionals in the health care field need to keep up to date information on the regulations for handling any type of biomedical or hazardous/chemical waste that is a result of services provided. While the most obvious concerns are those of public safety and possible health risks, if not stored or disposed of properly, this waste can also result in thousands of dollars in fines.  There are many types of health care waste to consider: biohazard, chemical, pathological, chemotherapy waste, etc. The waste produced by each office will determine the proper treatment and disposal. The Department of Health along with the state’s environmental and health departments regulate the storage, containment, treatment, and disposal of biomedical waste.

What is Biomedical Waste?

According to the State of Florida’s Bureau of Community Environmental Health, Biomedical waste is defined as any solid or liquid waste that may present a threat of infection to humans. The term includes, but is not limited to, nonliquid human tissue and body parts; laboratory and veterinary waste that contains human-disease-causing agents; discarded disposable sharps; human blood and human blood products and body fluids; and other materials that in the opinion of the Department of Health represent a significant risk of infection to persons outside the generating facility. The term does not include human remains that are disposed of by persons licensed under Chapter 497.

Biomedical Waste Storage and Containment

In Florida, biomedical waste generated from a facility cannot be stored for more than 30 days. The period of allowable storage begins from the moment a non-sharp article of biomedical waste is thrown into a red bag or a sharps container or when a sharps container is sealed. All containers, bags, or packages of waste must be clearly identifiable with the international biomedical waste symbol. All contained waste must remain sealed until treatment occurs. If a container should be ruptured, the original package must be placed into a new container without disrupting the original packaging. Any indoor storage area for biomedical waste must have restricted access and be described in the operating plan.  Outdoor storage areas must be clearly identifiable with the international biomedical waste symbol and have some form of security or protection against theft or vandalism. All symbols must be red, orange, or black and have a contrasting background color. All symbols must be a minimum of 6 inches in diameter.

Disposal of Biomedical Waste

Packages that are compacted should be incinerated or treated via approved treatment process. Other treatments must be approved via written request by the Department of Health. There are various treatment options available: treatments by gas, steam, chemical, dry temperatures, or microwaving are all approved and available. Waste may be disposed by transporting to a sanitary sewer system, an onsite sewage treatment disposal system. The disposal systems must be approved by the Department of Environmental Protection or the Department of Health.

Permitting

All facilities housing biomedical waste shall obtain an annual permit from the Department of Health. The form DH 4089, Application for Biomedical Waste Generator Permit/Exemption and the corresponding fees should be submitted to the local Department of Health facility. This permit needs to be renewed annually no later than September 30th of every year. If any facility eliminates less than 25 lbs of biomedical waste within a 30 day period, it is exempt from having to obtain permits and fee requirements. To qualify for exemption, documentation proving the weight of the waste generated for a 30 day period must be provided. After applications are submitted, the Department of Health will conduct an inspection of the facility to ensure compliance with section 381.0098 of the Florida Statutes. After inspection, the Department will notify if the facility is eligible to receive exemption.

Sharps Storage, Containment and Disposal

A permanently mounted sharps container is mandated by the state of Florida for businesses that use and dispose of needles. It must be labeled with the approved phrases of the international biomedical waste regulations. Containers must always be readily available and as close to the location of use as possible. The container should be disposed of once ¾ full to avoid any potentially dangerous contamination.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.