Sec. 2. 24-A MRSA §2759 is enacted to read:

§2759.__General anesthesia for dentistry

1.__General anesthesia and associated facility charges.__An insurer that issues individual contracts must provide that benefits are payable with respect to general anesthesia and associated facility charges for dental procedures rendered in a hospital, when the clinical status or underlying medical condition of a patient requires dental procedures that ordinarily would not require general anesthesia to be rendered in a hospital.__The insurer 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.

2.__Limitations on coverage.__This section applies only to general anesthesia and associated facility charges for only the following enrollees if the enrollees meet the criteria in subsection 1:

A.__Patients, including infants, exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, can not be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce a superior result;

B.__Patients demonstrating dental treatment needs for which local anesthesia is ineffective because of acute infection, anatomic variation or allergy;

C.__Extremely uncooperative, fearful, anxious or uncommunicative children or adolescents with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity; and

D.__Patients who have sustained extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised.

3.__Dental procedures and dentist's fee not covered.__This section does not require an insurer that issues individual contracts 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 is subject to all other terms and conditions of the insurance plan that apply generally to other benefits.

Sec. 3. 24-A MRSA §2847-J is enacted to read:

§2847-J.__General anesthesia for dentistry

1.__General anesthesia and associated facility charges.__An insurer that issues group contracts must provide that benefits are payable with respect to general anesthesia and associated facility charges for dental procedures rendered in a hospital, when the clinical status or underlying medical condition of a patient requires dental procedures that ordinarily would not require general anesthesia to be rendered in a hospital.__The insurer 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.

2.__Limitations on coverage.__This section applies only to general anesthesia and associated facility charges for only the following enrollees if the enrollees meet the criteria in subsection 1:

A.__Patients, including infants, exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, can not be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce a superior result;

B.__Patients demonstrating dental treatment needs for which local anesthesia is ineffective because of acute infection, anatomic variation or allergy;

C.__Extremely uncooperative, fearful, anxious or uncommunicative children or adolescents with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity; and

D.__Patients who have sustained extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised.

3.__Dental procedures and dentist's fee not covered.__This section does not require an insurer that issues group contracts 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 is subject to all other terms and conditions of the insurance plan that apply generally to other benefits.

Sec. 4. 24-A MRSA §4249 is enacted to read:

§4249.__General anesthesia for dentistry

1.__General anesthesia and associated facility charges.__ Individual and group contracts issued by a health maintenance organization must provide that benefits are payable with respect to general anesthesia and associated facility charges for dental procedures rendered in a hospital when the clinical status or underlying medical condition of a patient requires dental procedures that ordinarily would not require general anesthesia to be rendered in a hospital.__The insurer 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.

2.__Limitations on coverage.__This section applies only to general anesthesia and associated facility charges for only the following enrollees if the enrollees meet the criteria in subsection 1:

A.__Patients, including infants, exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, can not be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce a superior result;

B.__Patients demonstrating dental treatment needs for which local anesthesia is ineffective because of acute infection, anatomic variation or allergy;

C.__Extremely uncooperative, fearful, anxious or uncommunicative children or adolescents with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity; and

D.__Patients who have sustained extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised.

3.__Dental procedures and dentist's fee not covered.__This section does not require individual and group contracts issued by a health maintenance organization 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 is subject to all other terms and conditions of the insurance plan that apply generally to other benefits.

Sec. 5. Applicability. This Act applies to all policies and contracts executed, delivered, issued for delivery, continued or renewed on or after the effective date of this Act. All policies and contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.

SUMMARY

This bill requires that health insurers and health maintenance organizations provide coverage for general anesthesia and associated facility charges for dental procedures rendered in a hospital for certain eligible enrollees, including persons with developmental disabilities and persons whose health is compromised and for whom general anesthesia is medically necessary. This bill does not provide coverage for charges for the dental procedure itself, including, but not limited to, the professional fee of the dentist.