2002 Legislation
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SENATE BILL NO. 1338 – Dental procedures/anesthesia/insrnc

SENATE BILL NO. 1338

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S1338.......................................by COMMERCE AND HUMAN RESOURCES
DENTAL PROCEDURES - Adds to and amends existing law to provide for health
benefit plan and health care contract coverage of certain anesthesia and
hospital charges for dental procedures.
                                                                        
01/30    Senate intro - 1st rdg - to printing
01/31    Rpt prt - to Com/HuRes

Bill Text


                                                                        
                                                                        
  ||||              LEGISLATURE OF THE STATE OF IDAHO             ||||
 Fifty-sixth Legislature                  Second Regular Session - 2002
                                                                        
                                                                        
                                       IN THE SENATE
                                                                        
                                    SENATE BILL NO. 1338
                                                                        
                         BY COMMERCE AND HUMAN RESOURCES COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO INSURANCE; AMENDING CHAPTER 21, TITLE 41, IDAHO CODE, BY THE ADDI-
  3        TION OF A NEW SECTION 41-2147, IDAHO CODE, TO PROVIDE FOR  HEALTH  BENEFIT
  4        PLAN COVERAGE OF CERTAIN ANESTHESIA AND HOSPITAL CHARGES FOR DENTAL PROCE-
  5        DURES  AND TO DEFINE "HEALTH BENEFIT PLAN"; AMENDING CHAPTER 22, TITLE 41,
  6        IDAHO CODE, BY THE ADDITION OF A NEW SECTION 41-2224, IDAHO CODE, TO  PRO-
  7        VIDE  FOR  HEALTH BENEFIT PLAN COVERAGE OF CERTAIN ANESTHESIA AND HOSPITAL
  8        CHARGES FOR DENTAL PROCEDURES AND TO DEFINE "HEALTH BENEFIT PLAN";  AMEND-
  9        ING SECTION 41-3903, IDAHO CODE, TO FURTHER DEFINE "BASIC HEALTH CARE SER-
 10        VICES";  AND AMENDING CHAPTER 39, TITLE 41, IDAHO CODE, BY THE ADDITION OF
 11        A NEW SECTION 41-3933, IDAHO CODE, TO PROVIDE  FOR  HEALTH  CARE  CONTRACT
 12        COVERAGE OF CERTAIN ANESTHESIA AND HOSPITAL CHARGES FOR DENTAL PROCEDURES.
                                                                        
 13    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 14        SECTION  1.  That  Chapter  21,  Title 41, Idaho Code, be, and the same is
 15    hereby amended by the addition thereto of a NEW SECTION, to be known and  des-
 16    ignated as Section 41-2147, Idaho Code, and to read as follows:
                                                                        
 17        41-2147.  ANESTHESIA  AND  HOSPITAL  CHARGES  FOR DENTAL PROCEDURES. (1) A
 18    health benefit plan subject to the provisions of this  chapter  shall  provide
 19    coverage  for  payment of anesthesia and hospital or facility charges for ser-
 20    vices performed in a hospital or outpatient surgery center in connection  with
 21    dental procedures for:
 22        (a)  Children ten (10) years of age or younger; and
 23        (b)  Persons  who  have  a developmental disability, as defined in section
 24        66-402, Idaho Code.
 25        (2)  The same  deductibles,  coinsurance,  network  requirements,  medical
 26    necessity  provisions,  and  other  limitations that apply to physical illness
 27    benefits under the health benefit plan shall apply to coverage for  anesthesia
 28    and hospital or facility charges required to be covered under this section.
 29        (3)  As  used in this section, "health benefit plan" means any hospital or
 30    medical policy or certificate, or any  health  maintenance  organization  sub-
 31    scriber contract. "Health benefit plan" does not include: a policy or certifi-
 32    cate  of  insurance  for  a  specific disease; hospital confinement indemnity;
 33    accident-only, credit, dental, vision, medicare supplement, long-term care  or
 34    disability income insurance; coverage for student health benefits only; cover-
 35    age  issued  as  a supplement to liability insurance; worker's compensation or
 36    similar insurance;  automobile  medical  payment  insurance;  or  nonrenewable
 37    short-term coverage issued for a period of twelve (12) months or less.
                                                                        
 38        SECTION  2.  That  Chapter  22,  Title 41, Idaho Code, be, and the same is
 39    hereby amended by the addition thereto of a NEW SECTION, to be known and  des-
 40    ignated as Section 41-2224, Idaho Code, and to read as follows:
                                                                        
 41        41-2224.  ANESTHESIA  AND  HOSPITAL  CHARGES  FOR DENTAL PROCEDURES. (1) A
                                                                        
                                           2
                                                                        
  1    health benefit plan subject to the provisions of this  chapter  shall  provide
  2    coverage  for  payment of anesthesia and hospital or facility charges for ser-
  3    vices performed in a hospital or outpatient surgery center in connection  with
  4    dental procedures for:
  5        (a)  Children ten (10) years of age or younger; and
  6        (b)  Persons  who  have  a developmental disability, as defined in section
  7        66-402, Idaho Code.
  8        (2)  The same  deductibles,  coinsurance,  network  requirements,  medical
  9    necessity  provisions,  and  other  limitations that apply to physical illness
 10    benefits under the health benefit plan shall apply to coverage for  anesthesia
 11    and hospital or facility charges required to be covered under this section.
 12        (3)  As used in this section, "health benefit plan" means any group hospi-
 13    tal  or medical policy or certificate, or any group health maintenance organi-
 14    zation subscriber contract. "Health benefit plan" does not include:  a  policy
 15    or  certificate  of  insurance  for  a  specific disease; hospital confinement
 16    indemnity; accident-only, credit, dental, vision, medicare  supplement,  long-
 17    term care or disability income insurance; coverage for student health benefits
 18    only; coverage issued as a supplement to liability insurance; worker's compen-
 19    sation  or  similar  insurance;  automobile medical payment insurance; or non-
 20    renewable short-term coverage issued for a period of  twelve  (12)  months  or
 21    less.
                                                                        
 22        SECTION  3.  That  Section 41-3903, Idaho Code, be, and the same is hereby
 23    amended to read as follows:
                                                                        
 24        41-3903.  DEFINITIONS. (1) "Basic health care services" means the  follow-
 25    ing services: preventive care, emergency care, inpatient and outpatient hospi-
 26    tal  and   physician care, hospital-based rehabilitation treatment, diagnostic
 27    laboratory and diagnostic and therapeutic radiological  services.   Except  as
 28    provided  in  section  41-3933, Idaho Code, iIt does not include mental health
 29    services or services for alcohol or drug abuse, dental or vision  services  or
 30    long-term rehabilitation treatment.
 31        (2)  "Coinsurance"  means  a  percentage amount a member is responsible to
 32    pay out-of-pocket for health care services after satisfaction of  any applica-
 33    ble deductibles or copayments, or both.
 34        (3)  "Copayment" means an amount a member must pay to a provider  in  pay-
 35    ment for a specific health care service which is not fully prepaid.
 36        (4)  "Deductible"  means  the  amount of expense a member must first incur
 37    before the managed care organization begins payment for covered services.
 38        (5)  "Director" means the director of the department of insurance  of  the
 39    state of Idaho.
 40        (6)  "Emergency facility" means any hospital or other facility where emer-
 41    gency  services  are  provided  to  a  member including, but not limited to, a
 42    physician's office.
 43        (7)  "Emergency services" means those health care services that  are  pro-
 44    vided  in  a hospital or other emergency facility after the sudden onset of  a
 45    medical condition that manifests itself by  symptoms  of  sufficient  severity
 46    including, but not limited to, severe pain, that the absence of immediate med-
 47    ical  attention could reasonably be expected by a prudent person who possesses
 48    an average knowledge of health and medicine, to result in:
 49        (a)  Placing the patient's health in serious jeopardy;
 50        (b)  Serious impairment to bodily functions; or
 51        (c)  Serious dysfunction of any bodily organ or part.
 52        (8)  "Employer" means any person, firm, corporation, partnership or  asso-
 53    ciation.
                                                                        
                                           3
                                                                        
  1        (9)  "Enrollee"  means a person who either individually or through a group
  2    has entered into a contract for services under a managed care plan.
  3        (10) "General managed care plan" means a managed care plan which  provides
  4    directly  or arranges to provide, at a minimum, basic health care services.  A
  5    general managed care plan shall include basic health care services.
  6        (11) "Health care contract" means a contract entered  into  by  a  managed
  7    care organization and an enrollee.
  8        (12) "Health  care  services"  means those services offered or provided by
  9    health care facilities and health care providers relating to  the  prevention,
 10    cure or treatment of illness, injury or disease.
 11        (13) "Limited  managed care plan" means a managed care plan which provides
 12    dental care services, vision care services, mental health services,  substance
 13    abuse services, pharmaceutical services, podiatric care services or such other
 14    services  as the director may establish by rule to be limited health care ser-
 15    vices. Limited health care services shall not include hospital, medical,  sur-
 16    gical  or emergency services except as those services are provided incident to
 17    limited health care services.
 18        (14) "Managed care organization" means a public or private person or orga-
 19    nization which offers a  managed  care  plan.  Unless  otherwise  specifically
 20    stated,  the provisions of this chapter shall apply to any person or organiza-
 21    tion offering a managed care plan, whether or not a certificate  of  authority
 22    to offer the plan is required under this chapter.
 23        (15) "Managed care plan" means a contract of coverage given to an individ-
 24    ual,  family  or  group  of  covered individuals pursuant to which a member is
 25    entitled to receive a defined set of health care benefits through an organized
 26    system of health care providers in  exchange  for  defined  consideration  and
 27    which requires the member to use, or creates financial incentives for the mem-
 28    ber  to  use,  health care providers owned, managed, employed by or under con-
 29    tract with the managed care organization.
 30        (16) "Member" means a policyholder, enrollee or other individual  partici-
 31    pating in a managed care plan.
 32        (17) "Person"  means  any  natural or artificial person including, but not
 33    limited to, individuals, partnerships,  associations,  corporations  or  other
 34    legally recognized entities.
 35        (18) "Provider" means any physician, hospital, or other person licensed or
 36    otherwise authorized to furnish health care services.
 37        (19) "Utilization management program" means a system of reviewing the med-
 38    ical  necessity,  appropriateness, or quality of health care services and sup-
 39    plies provided under a managed care plan using specified  guidelines.  Such  a
 40    system  may  include,  but  is not limited to, preadmission certification, the
 41    application of practice guidelines, continued stay review, discharge planning,
 42    preauthorization of ambulatory procedures and retrospective review.
                                                                        
 43        SECTION 4.  That Chapter 39, Title 41, Idaho Code, be,  and  the  same  is
 44    hereby  amended by the addition thereto of a NEW SECTION, to be known and des-
 45    ignated as Section 41-3933, Idaho Code, and to read as follows:
                                                                        
 46        41-3933.  ANESTHESIA AND HOSPITAL CHARGES FOR  DENTAL  PROCEDURES.  (1)  A
 47    health  care contract which provides basic health care services subject to the
 48    provisions of this chapter shall provide coverage for  payment  of  anesthesia
 49    and  hospital or facility charges for services performed in a hospital or out-
 50    patient surgery center in connection with dental procedures for:
 51        (a)  Children ten (10) years of age or younger; and
 52        (b)  Persons who have a developmental disability, as  defined  in  section
 53        66-402, Idaho Code.
                                                                        
                                           4
                                                                        
  1        (2)  The  same  deductibles,  coinsurance,  network  requirements, medical
  2    necessity provisions, and other limitations that  apply  to  physical  illness
  3    benefits under the health care contract shall apply to coverage for anesthesia
  4    and hospital or facility charges required to be covered under this section.

Statement of Purpose / Fiscal Impact



                       STATEMENT OF PURPOSE
                           RS 11587C2

This bill requires health benefit plans in Idaho to provide
coverage for necessary general anesthesia and associated charges
when dental procedures must be performed on young children and
the developmentally disabled in hospital or outpatient surgical
care settings.  It would ensure that dental procedures for
special needs patients be performed safely and effectively
without using high-risk procedures.


                          FISCAL IMPACT

There would be no impact to the state general fund.

Contact
Name: Victoria Paulson, Idaho State Dental Association 
Phone: 208-659-2248
Rep. Hilde Kellogg
          


STATEMENT OF PURPOSE/FISCAL NOTE                   S 1338