REPUBLIC OF LITHUANIA

REPUBLIC OF LITHUANIA

LAW ON

DENTAL CARE (ASSISTANCE)

Chapter I

GENERAL PROVISIONS

Article 1. Purpose of the Law

This Law shall regulate the right to engage in the practice of doctor of dentistry, dental technician, oral hygienist and dental assistant professions, the procedure and control of performance of dental care (rendering of assistance), obligations and rights of dentists and dentist specialists, state regulation measures and grounds of liability.

Article 2. Basic Concepts

The following concepts shall be applied in this Law:

dental care (assistance) denoting that part of personal health care, intended for individual prophylaxis, diagnosis, treatment of the diseases of the mouth and dental prosthetics;

dental practice denoting that part of medical practice, in which doctors of general dentistry and doctor specialists in dentistry have a right to engage in;

doctor of general dentistry (further - dentist) denoting a doctor who holds a general dental practitioner’s licence;

doctor specialist in dentistry (further - dentist specialist), denoting a doctor who holds the licence of a dentist specialist (oral surgeon, specialist in prosthetics, endodontist, periodontist, orthodontist and pedodontist);

dental technician denoting a person who has acquired the licence of a dental technician in accordance with the procedure established by this Law;

oral hygienist denoting a person who has acquired the licence of an oral hygienist in accordance with the procedure established by this Law;

dental assistant denoting person who has acquired the licence of a dental assistant in accordance with the procedure established by this Law;

patient denoting a person who is making use of dental care (assistance);

dental care (assistance) institution (further- institution) denoting a personal health care institution, enterprise and organisation, which having obtained licencing and accreditation, in accordance with the procedure provided by law, must provide dental care and render dental assistance. Should such a licence be held solely by a part of the enterprise, this concept shall be applied to it, as well;

national health system dental care (assistance) institution of Lithuania (further-LNHSD) denoting a state or municipal institution, accredited to national health system activity of Lithuania according to the organisation levels, as established by laws and other legal acts;

(amended 25 September 1996)

certificate denotes a special document, attesting the specialist’s expertise in the performance of certain dental services;

licence of primary dental practice denoting document, which allows a person to engage in primary dental practice;

licence for specialised dental practice denotes a document which allows a person to engage in one of the types of specialised dental practice.

Chapter II

DENTAL CARE (ASSISTANCE) AND PRACTICE

Article 3. The Right to Engage in the Practice of Dentistry

1. The right to engage in the practice of dentistry is accorded to persons, holding a university diploma of a doctor of dentistry, obtained or nostrified in the Republic of Lithuania, who have completed the established residency requirement and have obtained a licence according to the procedure established by laws.

2. The right to provide certain dental care (assistance) services (further - dental care services) is granted through certification. The Ministry of Health approves the list of the types of dental care services requiring certification.

3. Licences to engage in the practice of dentistry and the certificates to provide certain dental care services shall be issued, renewed, suspended and revoked by theMinistry of Health, according to the Law on the Medical Doctor’s Practice and other legal acts (amended 25 September 1996).

4. Dentists shall be issued licences in accordance with the established procedure for issuance of licences for primary medical practice. The Ministry of Health shall establish the extent of dental practice and rendering of services.

5. Licences for dental specialists shall be issued in accordance with the established procedure for issuance of licences for the specialised practice of medicine. The Ministry of Health shall establish the types, extent and procedure for provision of services in specialised dental practice.

Article 4. The Right to Engage in the Practice of Dental Technology,
Oral Hygiene and Dental Assistance

1. The right to engage in the practice of dental technology shall be accorded to persons who have obtained a college diploma in dental technology, obtained or nostrified in the Republic of Lithuania, and have received a licence of dental technician. A dental technician who wishes to produce dental prostheses made of precious metals, must obtain a certificate.

2. The right to engage in the practice of oral hygiene shall be accorded to persons who have a university or college diploma, obtained or nostrified in the Republic of Lithuania and have acquired the licence of oral hygienist.

3. The right to engage in the practice of dental assistance shall be held by persons having a college dental assistant’s or medical nurse’s diploma, obtained or nostrified in the Republic of Lithuania and having obtained the licence of dental assistant.

4. The Ministry of Health shall issue licences and certificates of dental technician, oral hygienist or dental assistant.

5. Dental technicians, oral hygienists and dental assistants shall not have the right to engage in dental treatment or prosthetics practices.

Article 5. The Institutions of Dental Care (Assistance)

1. Institutions shall be founded, reorganised and closed according to the procedure established by this and other laws and legal acts.

2. Dental care (assistance) services may only be provided in institutions, licenced and accredited to provide dental care (assistance) or in enterprise branches that are accredited or certified to provide dental care (assistance). Accreditation shall be performed by the State Service for Accreditation of Health Care Activity at the Ministry of Health.

3. The Ministry of Health and the county governor shall found state institutions, while the local municipality shall found the municipal institutions.

4. Legal and natural persons may found private institutions. The founder of a dental care (assistance) institution must ensure that the dental care (assistance) institution shall be administered by a specialist, who holds a licence for the practice of dentistry.

5. All services essential for dental care (assistance) activity must be assembled within the institution. The Ministry of Health shall provide a list thereof. If the institution does not have all the required services available, it must draw up agreements with other accredited dental care (assistance) institutions.

Chapter III

RIGHTS OF DENTISTS, DENTISTRY SPECIALISTS AND PATIENTS, DUTIES AND PRINCIPLES OF LIABILITY

Article 6. Rights of Dentists and Dentist Specialists

1. Dentists and dentist specialists shall have a right to:

1) engage in the practice of dentistry in accordance with the procedure established by laws;

2) improve their professional knowledge;

3) select and prescribe medicines;

4) according to their competence issue personal health certificates in which data on dental care (assistance) are furnished;

5) refuse application of dental care (assistance) methods contrary to the principles of medical ethics and moral norms, if that shall not pose danger to the person’s health or life.

2. Dentists, dentist specialists, dental technicians, oral hygienists and dental assistants shall have the right, at the expense of the employer, to insurance against professional risk at work, which is established by other laws and legal acts.

Article 7. Obligations of Dentists and Dentist Specialists

Dentists and dentist specialists must:

1) provide essential dental care (render assistance);

2) provide proper dental care (render assistance), perform prophylaxis of diseases of the mouth;

3) observe the requirements of medical ethics;

4) administer medical documentation in accordance with the requirements of the legal acts in effect;

5) furnish statistical and other required records data;

6) inform the law and order and law enforcement bodies regarding patients, who may have been crime perpetrators, witnesses or victims;

7) furnish dental care data upon request by the Ministry of Health or law enforcement and law protection institutions (amended 25 September 1996);

8) employ only the treatment methods, equipment and materials (medical technologies) approved by the Ministry of Health;

9) contribute to preparation of dental profile specialists;

10) implement obligations and requirements of the laws and other legal acts.

Article 8. Illegal Practice of Dentistry

1. Illegal practice of dentistry comprises activity whereby a person shall:

1) engage in the practice of dentistry without having a licence or with an invalid licence;

2) engage in the practice of dentistry without a certificate, when it shall be required;

3) engage in the practice of dentistry in another speciality than that indicated on the licence;

4) illegally assume the name of a dentist.

2. A person engaged in illegal dental practice shall be held liable in accordance with the laws.

Article 9. Liability of Dentists and Dentist Specialists for Damages Inflicted
upon the Health of a Patient

Dentists and dentist specialists shall be liable in accordance with the procedure established by laws, for damage inflicted upon health of the patient.

Article 10. The Rights and Obligations of Patients

1. Patients shall have the right to:

1) select at their permanent place of residence a primary LNHSD activity organisational level municipal institution (general practice dental office) and the dentist working there;

2) select, upon the dentist’s referral, a dentist specialist of the corresponding speciality at institutions of secondary and tertiary LNHSD activity organisational level within outpatient county or state institutions;

3) select a private institution and the dentist or dentist specialist working there;

4) obtain information concerning institutions and the services they provide;

5) obtain information concerning the condition of one’s mouth organs, and also shall have a right to confidentiality of this information. Minors or legally incompetent persons must be furnished the aforementioned information in the presence of their legal representatives;

6) obtain information concerning the care (assistance), diagnostic and treatment methods, their possible consequences, permit their application or refuse them;

7) dispute the suitability or quality of the dental care (assistance) services received, and according to the procedure established by laws, receive compensation for harm caused through the fault of the dental care (assistance) institution or its employees;

8) avail himself, in accordance with the extent established by laws and within the established institutions, supported by the state or counties, (free) dental care (assistance) services.

2. Obligations of patients include:

1) looking after the care of one’s mouth and teeth;

2) implementing the instructions of dentists and dentist specialists;

3) informing the dentists, dentist specialists and oral hygienists who shall provide dental care (assistance) services, concerning the presence of an infection, especially one involving dangerous infectious diseases.

Chapter IV

COMPENSATION OF DENTAL CARE (ASSISTANCE) EXPENSES

Article 11. Sources of Compensation of Dental Care (Assistance) Expenses

1. Dental care (assistance) expenses may be compensated as follows:

1) from state or municipal funds (state or municipally - supported [free] dental care [assistance] services);

2) from mandatory health insurance funds;

3) from supplemental health insurance funds;

4) from voluntary contributions by patients.

2. Dental care (assistance) expenses shall be compensated in accordance with the procedure prescribed by laws and other legal acts.

Article 12. Persons Who Have the Right to State or Municipally-Supported
(Free) Dental Care (Assistance) Services at LNHSD Institutions

1. The following shall have a right to state or municipally-supported (free) dental care (assistance) services, provided at LNHSD:

1) citizens of the Republic of Lithuania and their minor children;

2) persons, permanently residing in Lithuania and their minor children;

3) persons not having citizenship of the Republic of Lithuania, but having the right to temporary residence in Lithuania, and their minor children.

2. Persons listed in part one of this Article, henceforth referred to as permanent residents.

3. Citizens of foreign states shall be provided free necessary dental care (assistance) services by LNHSD institutions, if international agreements of the Republic of Lithuania shall not establish otherwise.

4. The Ministry of Health along with the Ministry of Internal Affairs shall establish the procedure and forms for submittal of documents to LNHSD institutions, which shall attest to population members belonging to the listing of persons in part one of this Article, to LNHSD institutions.

Article 13. Establishment of the Nomenclature of Free Dental Care (Assistance)
Services Provided for Permanent Residents

1. Only the essential dental care (assistance) services shall be provided to permanent residents free of charge.

2. Categories of persons, as established by the Law on the Health System, shall be provided free dental care (assistance) services in accordance with a list of services, approved by the Government.

Article 14. Dental Care (Assistance) Services

1. Dental care (assistance) services comprise services provided in performing individual prophylaxis of diseases of organs of the mouth and the diagnosis, treatment and prosthetics of teeth.

2. The Ministry of Health shall compile a list (nomenclature) of primary, secondary and tertiary dental care services.

Article 15. Essential Dental Care (Assistance) Services

1. The following shall comprise essential dental care (assistance) services:

1) emergency dental assistance in cases of accidents or at the site of sudden life-threatening illness;

2) nearest, immediate institutional dental assistance;

3) immediate in-patient dental assistance at in-patient facilities.

2. The extent of essential dental care (assistance) and services, their principles, conditions and procedure and the competence of institutions and specialists in questions of provision of essential dental care (assistance), shall be established by the Ministry of Health.

Article 16. Basic Conditions for Obtaining (Free) Dental Care (Assistance)
at Municipal and State-Assisted LNHSD Institutions

1. The categories of persons established by the Law on the Health System shall be provided free dental care (assistance) services at LNHSD institutions in accordance with the approved by the Government list of these services provided, the following basic conditions shall be present:

1) the patient shall seek free dental services from a dentist, who is employed within a primary LNHSD activity organisational level institution of the area wherein the patient resides;

2) the patient shall seek free dental services from secondary or tertiary LNHSD activity organisational level institution. In this case the patient must submit a referral for free services, from a dentist on the staff of the primary LNHSD activity organisational level institution of the area wherein the patient resides;

3) the LNHSD institution which shall send the patient to another institution, shall provide a motivated requirement to further extend free dental care (assistance) services at another institution, describe the free dental services provided in accordance with requirements approved by the Ministry of Health.

2. Requirements listed in part one of this Article, shall not be applied to patients who shall apply to LNHSD institutions for essential dental care (assistance).

Article 17. Procedure of Municipal and State-Assisted (Free) Dental Care
(Assistance) at LNHSD Institutions

Procedural characteristics of free dental care (assistance) services provided to persons in categories established by the Law on the Health System, in accordance with the Government-approved list of such services, provided at LNHSD institutions:

1) free dental care (assistance) services at primary LNHSD activity organisational level institutions, located in corresponding municipal territory, shall be furnished only to residents of that municipality, with the exception of essential dental care (assistance);

2) free dental care (assistance) services at secondary LNHSD activity organisational level institutions shall be provided only to permanent residents of a corresponding county, with the exception of essential dental care (assistance);

3) free dental care (assistance) services for permanent residents of several counties or an entire country, may only be rendered by secondary LNHSD activity organisational level institutions included on the list approved by the Ministry of Health;

4) free dental care (assistance) services at tertiary LNHSD activity organisational level institutions shall be provided to permanent residents regardless of their location of residence;

5) university hospitals shall provide free primary and secondary dental care (assistance) services in accordance with the procedure and extent established by the Ministry of Health for scientific and instruction purposes;

6) free essential dental care (assistance) shall be rendered free of charge at LNHSD institutions without consideration of the number of visits by the patient to the institution, per calendar year.

Article 18. Information Provided to Residents Regarding Availability
of Free Dental Care (Assistance) Services

Heads of dental care (assistance) institutions must make accessible to the public some information regarding the type of dental care (assistance) services, supported (free of charge) by the state and municipalities available and the extent thereof. The Ministry of Health shall establish the procedure for supply of such information.

Article 19. Procedure for Providing Dental Care (Assistance) Services
at Institutions Compensated by Mandatory Health Insurance

1. Individual right to compensation of dental care (assistance) expenses from mandatory health insurance funds shall be established by laws and other legal acts.

2. Procedure of compensation of dental care (assistance) services rendered, by mandatory health insurance, shall be established by each LNHSD institution within the health care agreement with the territorial patients’ fund.

3. Every person shall have the right to access information regarding the extent and cost of services compensated through mandatory health insurance.

4. Persons, entitled to dental care (assistance) compensated by mandatory health insurance, must submit documents established by laws to the LNHSD institutions prior to seeking the services thereof.

Article 20. Procedure for Providing Compensated by Supplemental Insurance
Dental Care (Assistance) Services by Institutions

1. Procedure for rendering supplemental health insurance compensated dental care (assistance) services shall be established in the health care agreement between the institution and health insurance organisation.

2. Each person has a right to information concerning the extent of health services compensated by supplemental health insurance and the cost thereof.

Chapter V

SPECIAL FEATURES OF STATE REGULATION OF DENTAL CARE

(ASSISTANCE)

Article 21. Special Features of State Regulation of Dental Care (Assistance)
by Educational Institutions

1. The Government shall establish the procedure and extent of provision of dental care (assistance) services by state and municipal educational institutions.

2. Municipal institutions shall ensure in accordance with the procedure and extent established by the Government implementation of dental care (assistance) within municipal educational institutions.

3. The Ministry of Health along with the Ministry of Education and Science shall ensure the implementation of dental care (assistance) at the state educational institutions.

Article 22. Special Features of State Regulation of Dental Care (Assistance)
Services

1. The Ministry of Health, upon coordination with the State Service for Competition and Consumer Protection at the Government of the Republic of Lithuania shall establish the cost of dental care (assistance) services provided by state and municipal institutions.

2. The cost of dental care (assistance) services at private institutions shall be established by the owners thereof, however, they must not exceed 60 per cent of the costs of dental care (assistance) services, established by the Ministry of Health.

Article 23. Control of Dental Care (Assistance) Acceptability and Suitability

The Ministry of Health Shall establish the procedure of acceptability and suitability index control for dental care (assistance).

Article 24. Special Features of State Regulation of Dental Care (Assistance)
Advertising

Advertising of the methods of dental care (assistance) prophylaxis, diagnosis and treatment, as well as methods of hygiene, and also of equipment and materials (medical technologies) shall be permitted on condition:

1) these measures are approved by the Ministry of Health;

2) advertising is conducted in accordance with the procedure established by the Government.

Article 25. Special Features Applied to Persons, Who Have Acquired
Free University Education in Dentistry

1. Persons, who have acquired free university education in dentistry in the Republic of Lithuania, shall be required, upon completion of their university studies, to work for the duration of an established term, in state or municipal institutions, or to compensate the state budget for expenses incurred in the course of university studies.

2. The Government shall establish the terms and duration of mandatory work at state or municipal institutions, of persons who have acquired free university education in dentistry.

3. The Government shall establish the procedure for compensating university study expenses of persons who have acquired a free dental education and have refused to work in state or municipal institutions.

Article 26. Principles of State Regulation of the Prophylaxis of Diseases
of Organs of the Mouth

Oral hygienists, dental assistants, dentists and dentist specialists, in performing dental care (assistance), shall:

1) assess the condition of organs of the mouth, health factors contributing to it, needs and resources of dental care (assistance);

2) popularise information on prophylaxis of organs of the mouth diseases, instruct the public in the practice of mouth hygiene, consult patients on questions of dental care (assistance);

3) reduce the sickeness rate of organs of the mouth through use of special prophylactic measures;

4) block the spread of infectious diseases, present in saliva and blood.

2. These methods of prophylaxis shall be applied to:

1) persons under 16 years of age;

2) pregnant women;

3) mothers, covering the term of up to one year following the birth of a child;

4) persons who seek it;

3. The Ministry of Health shall establish the extent of the prophylaxis of organs of the mouth.

Article 27. Programmes of the Prophylaxis of Diseases of Organs of the Mouth

1. Programmes of prophylaxis of the organs of the mouth may be state or municipally-sponsored. The Ministry of Health shall implement and coordinate their preparation.

2. State programmes shall be approved by the Government on the recommendation of the Ministry of Health;

3. Municipal programmes shall be approved by the municipal council upon recommendation of the municipal physician.

4. Approved programmes must be implemented by natural and legal persons indicated therein.

Chapter VI

CONCLUDING PROVISIONS

Article 28. Liability for Violations of This Law

Legal and natural persons who have violated this Law, shall be liable in accordance with the laws.

Article 29. Coming into Effect of the Law

The Law on Dental Care (Assistance) shall come into effect in accordance with the procedure established by the Law on Implementation of the Law on Dental Care (Assistance).

I promulgate this Law passed by the Seimas of the Republic of Lithuania.

Algirdas Brazauskas

President of the Republic

Vilnius

March 28, 1996

No. I - 1246

(as amended by September 25, 1996)