1364-S AMH .... H2240.3

SHB 1364 - H AMD 0042 ADOPTED 3/12/01

By Representative

    On page 1, line 11, after "if" insert "such hospitalization is medically necessary because"

    On page 1, beginning on line 16, strike "as determined by the dentist"

EFFECT:  Allows carrier to monitor appropriateness of care.

SHB 1364 - H AMD

By Representative

    On page 2, line 5, after "with" insert "covered"

EFFECT:  Provides for anesthesia coverage under a dental plan only when underlying dental work is a covered benefit, i.e., if cosmetic dental work is not a covered benefit, anesthesia administered to do that dental work is not covered.

    On page 2, line 6, after "if" insert "such services are medically necessary because"

EFFECT:  Allows carrier to monitor appropriateness of care.

    On page 2, after line 27, insert the following:

    "(7) An employee benefit plan or health carrier that covers hospital or general anesthesia services under this section is not responsible for, or liable with respect to, the services of a dentist when those services are not covered by the carrier."

EFFECT:  Clarifies that a health plan or carrier is not liable for any fault on the part of a dentist to adhere to the accepted standard of care when the dentist has not been credentialed by the carrier or entered into a contractual relationship with the carrier.

    On page 2, line 30, after "provides" insert "group"

EFFECT:  Limits coverage to group insurance.

    On page 2, line 33, after "if" insert "such hospitalization is medically necessary because"

EFFECT:  Allows carrier to monitor appropriateness of care.

SHB 1364 - H AMD

By Representative

    On page 3, beginning on line 2, strike "as determined by the dentist"

EFFECT:  Allows carrier to monitor appropriateness of care.

    On page 3, line 8, after "provides" insert "group"

EFFECT:  Limits coverage to group insurance.

    On page 3, line 9, after "with" insert "covered"

EFFECT:  Provides for anesthesia coverage under a dental plan only when underlying dental work is a covered benefit, i.e., if cosmetic dental work is not a covered benefit, anesthesia administered to do that dental work is not covered.

    On page 3, line 10, after "if" insert "such services are medically necessary because"

EFFECT:  Allows carrier to monitor appropriateness of care.

    On page 3, after line 32, insert the following:

    "(7) Each health carrier that covers hospital or general anesthesia services under this section is not responsible for, or liable with respect to, the services of a dentist when those services are not covered by the carrier."

EFFECT:  Clarifies that a health carrier is not liable for any fault on the part of a dentist to adhere to the accepted standard of care when the dentist has not been credentialed by the carrier or entered into a contractual relationship with the carrier.

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