BILL NUMBER: AB 2003 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 15, 1998
AMENDED IN ASSEMBLY APRIL 21, 1998
AMENDED IN ASSEMBLY MARCH 30, 1998
INTRODUCED BY Assembly Member Strom-Martin
(Coauthor: Assembly Member Pacheco)
FEBRUARY 18, 1998
An act to add Section 1367.71 to the Health and Safety Code, and
to add Section 10119.9 to the Insurance Code, relating to health
coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2003, as amended, Strom-Martin. Health coverage: dental
treatments: anesthesia.
Existing law provides for the licensure and regulation of health
care service plans administered by the Commissioner of Corporations.
Under existing law, willful violation of any of these provisions is
a crime. Existing law also provides for the regulation of policies of
disability insurance administered by the Insurance Commissioner.
This bill would require provide that
specified health care service plans and disability insurers are
deemed, commencing January 1, 2000, to cover general
anesthesia and associated facility charges for dental
treatment procedures for patients
enrollees and insureds under 7 years of age,
patients or who are developmentally
disabled, and patients or for whom
general anesthesia is medically necessary, when
if rendered in a hospital or surgery center setting, when
the mental or physical clinical status or
underlying medical condition of the patient or insured requires
dental treatment procedures that ordinarily
would not require general anesthesia to be rendered in a
hospital or surgery center setting. The bill would authorize the
health care service plan or disability insurer to require prior
authorization of general anesthesia and associated charges required
for dental care procedures in the same manner that prior
authorization is required for other covered diseases or conditions.
Since the willful violation of the provisions relating to health care
service plans is a crime, this bill would impose a state-mandated
local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.71 is added to the Health and Safety Code,
to read:
1367.71. (a) A Every health care
service plan , other than a specialized health care service
plan, that is issued, amended, renewed, or delivered on or
after January 1, 2000, shall be deemed to cover general
anesthesia and associated facility charges for dental
treatment when procedures rendered in a hospital
or surgery center setting, when the mental or physical
clinical status or underlying medical condition
of the patient requires dental treatment
procedures that ordinarily would not require general anesthesia
to be rendered in a hospital or surgery center setting. The health
care service plan may require prior authorization of general
anesthesia and associated charges required for dental care procedures
in the same manner that prior authorization is required for other
covered diseases or conditions.
(b) This section shall apply only to general anesthesia and
associated facility charges for all of the following enrollees,
provided the enrollees meet the criteria in subdivision (a):
(1) Enrollees who are under seven years of age.
(2) Enrollees who are developmentally disabled, regardless of age.
(3) Enrollees whose health is compromised and for whom general
anesthesia is medically necessary, regardless of age.
(c) Nothing in this section shall require the health care service
plan to cover any charges for the dental procedure itself, including,
but not limited to, the professional fee of the dentist. Coverage
for anesthesia and associated facility charges pursuant to this
section shall be subject to all other terms and conditions of the
plan that apply generally to other benefits.
(d) Nothing in this section shall require health care service
plans to cover anesthesia or related facility charges for dental
procedures that ordinarily would require general anesthesia and that
do not meet the criteria specified in subdivision (a), (b), or (c).
(e) A health care service plan may include coverage
specified in subdivision (a) at any time prior to January 1, 2000.
(c) This section shall apply only to general anesthesia for any of
the following:
(1) Patients who are under seven years of age.
(2) Patients who are developmentally disabled, regardless of age.
(3) Patients whose health is compromised and for whom general
anesthesia is medically necessary, regardless of age.
SEC. 2. Section 10119.9 is added to the Insurance Code, to read:
10119.9. (a) A disability insurance policy or certificate
covering hospital, surgical, or medical expenses, that
meets the definition of "health benefit plan" in subdivision (a) of
Section 10198.6, that is issued, amended, renewed, or delivered
on or after January 1, 2000, shall be deemed to cover
general anesthesia and associated facility charges for dental
treatment when procedures rendered in a
hospital or surgery center setting, when the mental or
physical clinical status or underlying medical
condition of the insured requires dental treatment
procedures that ordinarily would not require general anesthesia
to be rendered in a hospital or surgery center setting. The
disability insurance policy or certificate may require
prior authorization of general anesthesia and associated charges
required for dental care procedures in the same manner that prior
authorization is required for other covered diseases or conditions.
(b) This section shall apply only to general anesthesia and
associated facility charges for all of the following insureds,
provided the insureds meet the criteria in subdivision (a):
(1) Insureds who are under seven years of age.
(2) Insureds who are developmentally disabled, regardless of age.
(3) Insureds whose health is compromised and for whom general
anesthesia is medically necessary, regardless of age.
(c) Nothing in this section shall require insureds to cover any
charges for the dental procedure itself, including the professional
fee of the dentist. Coverage for anesthesia and associated facility
charges pursuant to this section shall be subject to all other terms
and conditions of the policy or certificate that apply generally to
other benefits.
(d) Nothing in this section shall require insurers to cover
anesthesia or related facility charges for dental procedures that
ordinarily would require general anesthesia and that do not meet the
requirements of subdivision (a), (b), or (c).
(e) A disability insurance policy may include coverage
specified in subdivision (a) at any time prior to January 1, 2000.
(c) This section shall apply only to general anesthesia for the
following:
(1) Patients who are under seven years of age.
(2) Patients who are developmentally disabled, regardless of age.
(3) Patients whose health is compromised and for whom general
anesthesia is medically necessary, regardless of age.
SEC. 3. No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB of the California Constitution because the
only costs that may be incurred by a local agency or school district
will be incurred because this act creates a new crime or infraction,
eliminates a crime or infraction, or changes the penalty for a crime
or infraction, within the meaning of Section 17556 of the Government
Code, or changes the definition of a crime within the meaning of
Section 6 of Article XIIIB of the California Constitution.
Notwithstanding Section 17580 of the Government Code, unless
otherwise specified, the provisions of this act shall become
operative on the same date that the act takes effect pursuant to the
California Constitution.