Bill Text: PA HB1049 | 2009-2010 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Providing mandatory insurance coverage for general anesthesia for dental care for certain persons.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2009-10-08 - Re-committed to APPROPRIATIONS [HB1049 Detail]

Download: Pennsylvania-2009-HB1049-Introduced.html

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PRINTER'S NO. 1220
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1049 Session of2009
INTRODUCED BY SAYLOR, BAKER, BARRAR, BELFANTI, BEYER, BRENNAN, BRIGGS, CASORIO, CREIGHTON, DERMODY, DiGIROLAMO, FAIRCHILD, FLECK, FREEMAN, GEIST, GEORGE, GIBBONS, GINGRICH, GROVE, HALUSKA, HARHART, HARPER, HELM, HESS, HORNAMAN, KORTZ, KOTIK, MAHER, MAHONEY, MELIO, METZGAR, MILLARD, MILLER, MOUL, MUNDY, MURT, M. O'BRIEN, O'NEILL, PICKETT, QUINN, RAPP, READSHAW, REICHLEY, SIPTROTH, K. SMITH, SOLOBAY, STABACK, STURLA, VULAKOVICH, WALKO, WANSACZ AND WATSON, MARCH 23, 2009
REFERRED TO COMMITTEE ON INSURANCE, MARCH 23, 2009
AN ACT
Providing mandatory insurance coverage for general anesthesia
for dental care for certain persons.
The General Assembly finds and declares as follows:
(1) Tooth decay is the single most common chronic
disease of childhood. Dental treatment for children is
imperative to maintain their health.
(2) Children suffer significant morbidity from tooth
decay, including pain, infection, dysfunction, poor
appearance and missed school days.
(3) The necessity for dentists to utilize general
anesthesia may occur on the very young, disabled or special
needs patients, where the dental treatment is not deemed
possible without general anesthesia by the dentist.
(4) Because general anesthesia for dental treatment is
not covered by some health insurance policies, the result can
be treatment with compromised outcomes, parents subjected to
incurred expenses or treatment not performed at the expense
of the child's health.
(5) Mandatory insurance coverage for general anesthesia
for dental treatment is essential to ensure that all children
receive the dental treatment they need to maintain good
health.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Children's
and Special Needs Patient's Access to Quality Dental Care Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Associated medical costs." Hospitalization and related
medical expenses, such as the administration of general
anesthesia when dental treatment must be performed in a dental
office.
"Dental care." The diagnosis, treatment planning and
implementation of services directed at the prevention and
treatment of diseases, conditions and dysfunctions relating to
the oral cavity and its associated structures and their impact
upon the human body, or the implementation of professional
dental care, which includes diagnostic, preventive, therapeutic,
restorative, oral and maxillofacial, surgical, endodontic,
prosthodontic, orthodontic, periodontic and aesthetic (cosmetic)
services provided to dental patients by a legally qualified
dentist or physician operating within the scope of the dentist
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or physician's training.
"Eligible dental patient."
(1) A dental patient who is severely disabled mentally,
physically, developmentally, emotionally or behaviorally, and
the patient is an extremely uncooperative, unmanageable,
anxious, fearful individual or is an uncommunicative
individual with dental needs deemed sufficiently important
that dental care cannot be deferred.
(2) Children under five years of age.
"General anesthesia." A controlled state of unconsciousness,
including deep sedation, that is produced by a pharmacologic
method, a nonpharmacologic method or a combination of both and
that is accompanied by a complete or partial loss of protective
reflexes that include the patient's inability to maintain an
airway independently and to respond purposefully to physical
stimulation or verbal command.
"Health care facility." Any health care facility providing
clinically related health services, including, but not limited
to, a general or special hospital, including psychiatric
hospitals, rehabilitation hospitals, ambulatory surgical
facilities, long-term care nursing facilities, cancer treatment
centers using radiation therapy on an ambulatory basis and
inpatient drug and alcohol treatment facilities, both profit and
nonprofit and including those operated by an agency or State or
local government. The term shall also include a hospice. The
term shall not include an office used primarily for the private
or group practice by health care practitioners where no
reviewable clinically related health service is offered, a
facility providing treatment solely on the basis of prayer or
spiritual means in accordance with the tenets of any church or
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religious denomination or a facility conducted by a religious
organization for the purpose of providing health care services
exclusively to clergy or other persons in a religious profession
who are members of the religious denominations conducting the
facility.
"Health insurance policy." An individual or group health,
sickness or accident policy, subscriber contract or certificate
issued by an entity subject to this act or any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) or 63 (relating to professional health services
plan corporations).
(5) Medical assistance.
The term does not include any of the following types of
policies: accident only, fixed indemnity, limited benefit,
credit, dental, vision, specified disease, Medicare
supplemental, Civilian Health and Medical Program of the Uniform
Services (CHAMPUS) supplement, long-term care, disability
income, workers' compensation or automobile medical payment.
Section 3. Required coverage.
(a) General rule.--
(1) Every health insurance policy shall cover general
anesthesia and associated medical costs provided to an
eligible dental patient.
(2) A health insurance carrier may require authorization
of hospitalization for dental care procedures in the same
manner that prior authorization is required for
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hospitalization for other covered diseases or conditions.
(3) A policy of accident and health insurance providing
coverage to a resident of this Commonwealth must also provide
coverage for general anesthesia and associated medical costs
derived by its administration and billed by a dentist for an
eligible dental patient, excluding dental care covered under
the health plan, regardless of whether the services are
provided in a health care facility or a dental office.
(4) This act shall not be construed to require coverage
for the dental care for which the general anesthesia is
provided.
(5) The provisions of this act shall not apply to dental
care rendered for temporal mandibular joint disorders.
(b) Coverage subject to annual deductible, copayment or
coinsurance requirements.--The coverage required under this act
shall be subject to the annual deductible, copayment or
coinsurance requirements imposed by an entity subject to this
act for similar coverages under the same health insurance policy
or contract.
Section 4. Delivery of policy.
If a health insurance policy provides coverage or benefits to
a resident of this Commonwealth, it shall be deemed to be
delivered in this Commonwealth within the meaning of this act,
regardless of whether the health care insurer issuing or
delivering the policy is located within or outside this
Commonwealth.
Section 5. Repeals.
All acts and parts of acts are repealed insofar as they are
inconsistent with this act.
Section 6. Applicability.
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This act shall apply to all health insurance policies issued
under any group master policy or individual policy delivered or
issued for delivery on or after the effective date of this
section only to residents of this Commonwealth and to renewals
of such policies on or after the effective date of this section.
Section 20. Effective date.
This act shall take effect in 180 days.
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