Why does the Board
review management and business services agreements entered into by
its licensed dentists?
As the State’s dental regulatory agency, the Board
has the responsibility of protecting the public by ensuring that
only licensed dentists are engaging in the practice of dentistry in
North Carolina. The State Legislature has determined that the
“practice of dentistry” not only includes a person who provides
clinical dental care to patients but also extends to any person or
entity that “owns, manages, supervises, controls or conducts any
enterprise” wherein acts constituting the practice of dentistry
are performed. N.C. Gen. § 90-29(b)(11). The Dental Practice Act
is found in Chapter 90, Article 2 of the
North Carolina General Statutes
and can be accessed on this website.
Dental Board adopted a regulation, the
Management Arrangements Rule ( “MAR”), to implement
the above provision of the Dental Practice Act. 21 NCAC 16X .0101.
The MAR also can be accessed on this website.
Licensed dentists must ensure that they do not enter into any
impermissible arrangements with unlicensed individuals or entities
for the provision of management or business support services
("management services provider"). Otherwise, a licensed dentist may
be subject to discipline by the Board for permitting his or her name
to be used by an unlicensed individual or entity or for aiding,
abetting or assisting the illegal practice of dentistry.
What agreements or
arrangements must be submitted for review by the Dental Board?
The MAR requires that the Board review arrangements or agreements
for the provision of defined, bundled or other business or
management services to ensure that they comply with the law.
is the responsibility of both licensed dentists and management
services providers to submit all actual or proposed arrangements for
bundled or other business services to the Board for review.
Arrangements that must be reviewed by the Board include the
1.Any proposed management arrangement that has not been
executed by the parties and has not previously been reviewed by the
2.Any management arrangement executed by the parties but not
previously reviewed by the Board that wasentered into after
April 1, 2001, the effective date of the MAR.
3.Any management arrangementthat has been previously reviewed by
the Board and is about to be or has been renewed or extended beyond
its original terms by the parties, whether or not the extension
requires actions by the parties or occurs automatically.
4.Any management arrangement previously reviewed by the Board
that has subsequently been amended or is about to be amended.
5.Any management arrangement in which the professional entity,
dentist or management services provider has changed, even if the
arrangement was previously reviewed by the Board.
6.Any executed management arrangement in which a practice
location is being added or changed, even if the arrangement was
previously reviewed by the Board.
Licensed dentists and others are
generally NOT required to submit the following type of agreements:
·Agreements for the
provision of legal, financial or other services not related to the
provision of management services for a fee;
arrangements (as defined by the MAR) between an employee and the
To comply with
the MAR, any licensed dentist submitting an actual or proposed
agreement to the Board for review must do so by providing a written
agreement setting forth “all material terms of the arrangement
between or among the parties thereto.” The Board will provide its
determination regarding whether the agreement complies with the law
within a reasonable time and without undue delay once it receives a
complete submission. However, the Board will not begin its process
of reviewing a management arrangement until it has received a
complete submission. If you have questions about whether an
agreement must be submitted for review or what documentation to
include, you may contact the Board's office for further guidance.
What are the
responsibilities of a licensed dentist and management services
provider in submitting management or business services agreements to
the Board for review?
dentist is responsible for ensuring that its contractual
relationships, and the submission of contractual arrangements to the
Board, comply with the requirements of the Dental Practice Act and
the MAR. In addition, the Board has statutory authority to seek
relief in the courts to enjoin a third-party provider of business
support or management services from entering into and operating
under agreements in violation of State law.
Has the Board
provided any guidance on agreements or arrangements that comply with
the Dental Laws?
Yes. The Dental Board
has reviewed and deemed an
example management services agreement
compliant with the Dental Practice Act and the MAR. This agreement
merely provides an example that the Dental Board has concluded
complies with its governing laws. Other agreements, including
variations of provisions contained in the example agreement, also
may comply with the pertinent dental laws. The Dental Board reviews
each management services agreement or proposed agreement on a
case-by-case basis to determine its compliance. The Dental Board
cannot provide copies of other agreements submitted to it for review
by parties because those documents, as well as any related
investigative information, are privileged and confidential.
What documents must
be submitted to the Dental Board for it to begin reviewing a
The Board will
not consider a management agreement submitted for review complete
and ready for review unless it contains at least the following
1.A copy of all actual, proposed or anticipated contracts and
other written documents, which contain all the terms of any
agreement or arrangement between the licensed dentist/professional
entity, or anyone working in the dental practice, and the management
services provider or any of its affiliates.
2.A written summary of all actual, proposed or contemplated
oral agreements or arrangements between the licensed
dentist/professional entity, or anyone working in the dental
practice, and the management services provider or any of its
3.A notarized verification from the licensed dentist that the
Board has been provided all required information and that the
information is accurate.
4.A notarized verification from the management services
provider with whom the licensed dentists will contract that the
Board has been provided all required information and that the
information is accurate.
verification forms may be downloaded from this site using Adobe
Acrobat Reader. The Acrobat Reader can be downloaded from the site.
the above documents, including executed, notarized verification
forms from both the licensed dentists and the management services
provider, will shorten the time period necessary for the Board’s
review of the arrangement.
Based on the complexity
and nature of the management arrangement, the Board may determine
that it requires information in addition to that listed above in
order to conduct its review. In such cases, the Board will notify
the licensed dentist and management services provider of any
additional information that is required.
What is the Board’s
process for reviewing a management arrangement once it has been
process in reviewing a management arrangement is summarized in the
following five steps:
Upon the receipt by the Board of a management arrangement for
review, the information will be assigned to an Investigation Panel
(IP) of the Board, which includes a Board member serving as the Case
Officer. The IP will ascertain if the licensed dentist and
management services provider appear to have submitted all the
information needed to conduct a full review, including the
information listed above. If the IP determines that more
information is required, it will notify the licensed dentist and the
management services provider regarding what additional information
2. Initial Review-
Once the IP has received all required information, the IP will begin
its review. This initial review typically is completed within
forty-five (45) days after receipt of a complete submission.
Once the IP completes its review, it will notify the licensed
dentist and management services provider of its findings and
conclusions. If the IP believes that the management arrangement
complies with the Dental Practice Act and the MAR, the matter will
be submitted to the full Board for its review and determination.
3. Right to Resubmit
Revised Arrangement- If the IP concludes that the
management arrangement does not comply with the Dental Practice Act
and the MAR, it will provide the licensed dentist and management
services provider an explanation of the reasons for its finding of
noncompliance. The licensed dentist and the management services
provider will be afforded the opportunity to submit a revised
version of the management arrangement or other response to the IP
4. Review by Full Board
- The IP thereafter will present its findings and recommendations
concerning the management arrangement (or revised management
arrangement) to a Hearing Panel of the Board at an Investigatory
Review Conference (IRC). The Board member serving as the Case
Officer on the IP will not serve on the Hearing Panel at the IRC.
The licensed dentist and the management services provider have the
opportunity to offer their position and argument at the IRC. The
IRC will typically be scheduled within sixty (60) days after
the IP completes its initial review and provides written
notification of the management arrangement being non-compliant.
5. Board Advisory Opinion
- The Hearing Panel of the Board will issue an advisory opinion
indicating whether the management arrangement at issue complies with
applicable North Carolina law. Typically, the Hearing Panel will
issue its advisory opinion concerning the arrangement within
thirty (30) days of the IRC. A copy of the advisory opinion
will be provided to the licensed dentist and management services
strives to meet the timeframes outlined above. The review time
frames may be adjusted depending on a number of factors, such as the
need for clarifying information, the complexity of the arrangement,and potentially the number
and complexity of other management arrangements under review
concurrently, among others. Regardless, the Board shall complete
the review of the management arrangement without undue delay.
All correspondence and submissions should be directed to the Board
office as follows:
North Carolina State Board of Dental Examiners
Management Arrangement Review
507 Airport Boulevard, Suite 105
Morrisville, North Carolina 27560