ANALYSIS OF HOUSE BILL 1889

                     Mandating general anesthesia services.

Health Care Committee                         February 18, 1999

Washington State House of Representatives

SPONSORS:  Representatives Pflug and Cody.

BACKGROUND:  HB 2540 (1998) required health plans to cover general anesthesia for dental use for a covered person who:  (1) is a child under age six; (2) is severely disabled; or (3) has a medical condition requiring hospitalization or general anesthesia for dental care treatment.  The bill was referred to the Department of Health (DOH) for Sunset Review.

The DOH recommended that general anesthesia for dental use be a covered benefit in health plans,  but that there should be coordination of benefits between medical and dental plans, e.g., medical plans should cover the cost of general anesthesia and related facility charges when the procedure takes place in a hospital or surgical center environment, and dental plans should cover the cost of general anesthesia and related charged when the procedure takes place in a dental office.  (See attached.)

SUMMARY:  Public employee plans provided by the State Health Care Authority [HCA] and health plans offered by a health carrier must provide dental anesthesia for enrollees who are under the age of seven, or physically or developmentally disabled as follows:

If the person cannot be safely and effectively treated in a dental office, coverage must be provided by the medical-related plan.

If the person can be safely and effectively treated in a dental office, coverage must be provided by the dental-related plan.

Also, related medical plans must cover a person with at least one medical condition that would create an undue medical risk if treatment were not performed in a hospital or ambulatory surgery center; such treatment must be approved by the patient's physician.

Standard cost-sharing and prior authorization requirements may be imposed.

Carriers and the HCA are not limited in negotiating rates and contracts with specific providers.

These provisions do not apply to Medicare supplemental coverage or other limited benefit policies.