BY REPRESENTATIVES Lawrence, K. Alexander, Musgrave, Chavez, Clarke, Mace, Saliman, Snyder, and Tool;
also SENATORS Hopper, Hernandez, Linkhart, Pascoe,
Rupert, and Thiebaut.
CONCERNING REQUIRED HEALTH CARE COVERAGE FOR MEDICAL
COSTS ASSOCIATED WITH THE ADMINISTRATION OF GENERAL ANESTHESIA
FOR DENTAL PROCEDURES PERFORMED ON DEPENDENT CHILDREN.
Be it enacted by the General Assembly of the State
of Colorado:
SECTION 1. Legislative declaration.
The general assembly finds, determines, and declares that dental
treatment for certain children is imperative to maintain their
health. Occasionally, it is necessary for dentists to utilize
anesthesia to perform dental treatment on very young, disabled,
or medically compromised children. However, as it is usually
not an included benefit of the child's medical or dental insurance
coverage, either the parents are left with the incurred expenses,
or the treatment is not performed at the expense of the child's
health. The general assembly further finds, determines, and declares
that mandatory insurance coverage for anesthesia for dental treatment
is essential to ensure that all children receive the dental treatment
they need to maintain good health.
SECTION 2. 1016104,
Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW
SUBSECTION to read:
1016104. Mandatory coverage
provisions. (12) Hospitalization
and general anesthesia for dental procedures for dependent children.
(a) ALL INDIVIDUAL AND ALL GROUP SICKNESS AND ACCIDENT
INSURANCE POLICIES THAT ARE DELIVERED OR ISSUED FOR DELIVERY WITHIN
THE STATE BY AN ENTITY SUBJECT TO THE PROVISIONS OF PART 2 OF
THIS ARTICLE AND ALL INDIVIDUAL AND GROUP HEALTH CARE SERVICE
OR INDEMNITY CONTRACTS ISSUED BY AN ENTITY SUBJECT TO THE PROVISIONS
OF PART 3 OR 4 OF THIS ARTICLE EXCEPT SUPPLEMENTAL POLICIES THAT
COVER A SPECIFIC DISEASE OR OTHER LIMITED BENEFIT SHALL PROVIDE
COVERAGES FOR GENERAL ANESTHESIA WHEN RENDERED IN A HOSPITAL,
OUTPATIENT SURGICAL FACILITY, OR OTHER FACILITY LICENSED PURSUANT
TO SECTION 253101, C.R.S., AND FOR ASSOCIATED HOSPITAL
OR FACILITY CHARGES FOR DENTAL CARE PROVIDED TO A DEPENDENT CHILD,
AS DEPENDANT IS DEFINED IN SECTION 1016102 (14), OF
A COVERED PERSON. SUCH DEPENDENT CHILD SHALL, IN THE TREATING
DENTIST'S OPINION, SATISFY ONE OR MORE OF THE FOLLOWING CRITERIA:
(I) THE CHILD HAS A PHYSICAL, MENTAL,
OR MEDICALLY COMPROMISING CONDITION; OR
(II) THE CHILD HAS DENTAL NEEDS FOR WHICH
LOCAL ANESTHESIA IS INEFFECTIVE BECAUSE OF ACUTE INFECTION, ANATOMIC
VARIATIONS, OR ALLERGY; OR
(III) THE CHILD IS AN EXTREMELY UNCOOPERATIVE,
UNMANAGEABLE, ANXIOUS, OR UNCOMMUNICATIVE CHILD OR ADOLESCENT
WITH DENTAL NEEDS DEEMED SUFFICIENTLY IMPORTANT THAT DENTAL CARE
CANNOT BE DEFERRED; OR
(IV) THE CHILD HAS SUSTAINED EXTENSIVE
OROFACIAL AND DENTAL TRAUMA.
(b) A CARRIER MAY:
(I) REQUIRE PRIOR AUTHORIZATION FOR GENERAL
ANESTHESIA AND OUTPATIENT SURGICAL FACILITIES OR HOSPITALIZATION
FOR DENTAL CARE PROCEDURES IN THE SAME MANNER THAT PRIOR AUTHORIZATION
IS REQUIRED FOR HOSPITALIZATION FOR OTHER COVERED DISEASES OR
CONDITIONS; AND
(II) REQUIRE THAT IF COVERAGE IS PROVIDED THROUGH A MANAGED CARE PLAN, THE BENEFITS MANDATED PURSUANT TO THIS SUBSECTION (12) SHALL BE COVERED BENEFITS ONLY IF THE SERVICES ARE RENDERED BY A PROVIDER WHO IS DESIGNATED BY AND AFFILIATED WITH THE CARRIER; AND
(III) RESTRICT COVERAGE TO INCLUDE ANESTHESIA
PROVIDED BY AN ANESTHESIA PROVIDER ONLY DURING PROCEDURES PERFORMED
BY AN EDUCATIONALLY QUALIFIED SPECIALIST IN PEDIATRIC DENTISTRY
OR OTHER DENTIST EDUCATIONALLY QUALIFIED IN A RECOGNIZED DENTAL
SPECIALTY FOR WHICH HOSPITAL PRIVILEGES ARE GRANTED OR WHO IS
CERTIFIED BY VIRTUE OF COMPLETION OF AN ACCREDITED PROGRAM OF
POSTGRADUATE HOSPITAL TRAINING TO BE GRANTED HOSPITAL PRIVILEGES.
(c) THE PROVISIONS OF THIS SUBSECTION
(12) SHALL NOT APPLY TO TREATMENT RENDERED FOR TEMPORAL MANDIBULAR
JOINT (TMJ) DISORDERS.
SECTION 3. Effective
date applicability. (1) This act shall
take effect on September 1, 1998; except that, if a referendum
petition is filed against this act or an item, section, or part
of this act within the ninetyday period after final adjournment
of the general assembly that is allowed for submitting a referendum
petition pursuant to article V, section 1 (3) of the state constitution,
then the act, item, section, or part, if approved by the people,
shall take effect on the date of the official declaration of the
vote thereon by proclamation of the governor.
(2) The provisions of this act shall apply
to all individual and all group sickness and accident insurance
policies that are delivered or issued for delivery within the
state by an entity subject to the provisions of part 2 of article
16 of title 10, Colorado Revised Statutes, and all individual
and group health care service or indemnity contracts issued, renewed,
or reinstated by an entity subject to the provisions of part 3
or 4 of article 16 of title 10, Colorado Revised Statutes, on
or after the effective date of this act.
____________________________ ____________________________
Charles E. Berry Tom Norton
SPEAKER OF THE HOUSE PRESIDENT OF
OF REPRESENTATIVES THE SENATE
____________________________ ____________________________
Judith M. Rodrigue Patricia K. Dicks
CHIEF CLERK OF THE HOUSE ASSISTANT SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
_________________________________________
Roy Romer
GOVERNOR OF THE STATE
OF COLORADO