HOUSE BILL REPORT
HB 1889
As Reported By House Committee On:
Health Care
Title: An act relating to general anesthesia services.
Brief Description: Mandating general anesthesia services.
Sponsors: Representatives Pflug and Cody.
Brief History:
Committee Activity:
Health Care: 2/19/99, 3/2/99 [DPS].
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Brief Summary of Substitute Bill
$Delineates health carrier responsibility for dental anesthesia coverage to defined categories of covered person in certain health settings.
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HOUSE COMMITTEE ON HEALTH CARE
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 8 members: Representatives Cody, Democratic Co-Chair; Parlette, Republican Co-Chair; Pflug, Republican Vice Chair; Campbell; Conway; Edmonds; Edwards and Ruderman.
Minority Report: Do not pass. Signed by 3 members: Representatives Alexander; Boldt and Mulliken.
Staff: Bill Hagens (786-7131).
Background:
Legislation introduced in 1998 required health plans to cover dental anesthesia 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 issue 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 charges when the procedure takes place in a dental office.
Summary of Substitute Bill:
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 provide dental anesthesia services to a covered 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 and may require services be provided in participating facilities.
These provisions do not apply to Medicare supplemental coverage or other limited benefit policies.
Substitute Bill Compared to Original Bill: Clarifies that the bill does not affect existing contracts and that a carrier may require services be provided in facilities that it owns or with which it contracts.
Appropriation: None.
Fiscal Note: Available.
Effective Date of Substitute Bill: Ninety days after adjournment of session in which bill is passed.
Testimony For: (original bill) Present law needs clarification on carrier responsibility for providing dental anesthesia. This bill is necessary to ensure that patients receive care in appropriate settings. Because of the small number of eligible patients, costs should not be too large.
Testimony Against: (original bill) The bill requires carriers that provide comprehensive health coverage to pay for services that should be the responsibility of dental insurers. The bill is unclear on who has the authority to order care and how benefits will be coordinated among carriers.
Testified: (original bill) (support) Dr. Bryan Willams, Dr. Bertha Berriga, and Dr. Richard Crinzi, Washington State Dental Association.
(information) Steve Boruchowitz, Department of Health.
(oppose) Ken Bertrand, Group Health.