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F I S C A L I M P A C T R E P O R T

SPONSOR Garcia, M.H.

ORIGINAL DATE

LAST UPDATED

2/7/06

HB HJM 67

SHORT TITLE Insurance Coverage for Dental Anesthesia

SB

ANALYST Lewis

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY06

FY07

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

Duplicates SJM 54.

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Human Services Department (HSD)

Health Policy Commission (HPC)

No Response Received From

Public Regulation Commission (PRC)

SUMMARY

Synopsis of Bill

House Joint Memorial 67 requests that the New Mexico Legislative Council direct the appropri-

ate interim committee to

receive testimony on the lack of health insurance coverage for general anesthesia for

pediatric dentistry; and

recommend legislation for the next regular legislative session.

HJM 67 further requests that copies of this memorial be transmitted to the co-chairs of the New

Mexico Legislative Council.

House Joint Memorial 67 – Page

2

FISCAL IMPLICATIONS

No fiscal impact.

SIGNIFICANT ISSUES

According to the Health Policy Commission (HPC), this joint memorial recognizes the impor-

tance of early oral health intervention and prevention to avoid potential future health issues and

the cost dilemma for some families in which treatment may be postponed indefinitely if their in-

surance does not provide such coverage.

The HPC notes, however, that health insurance plans do not normally cover dental benefits ex-

cept for medically necessary procedures such as dental work required due to injury or other non-

cosmetic situations. Dental plans may have various levels of coverage in which general anesthe-

sia may be covered for a given procedure.

According to the Human Services Department (HSD), the Medicaid program does cover anes-

thesia for Medicaid-eligible clients when either:

the nature of the surgery makes anesthesia necessary, or

the recipient’s situation makes it necessary, such as for a developmentally disabled individual

who may make a dental procedure dangerous if anesthesia is not used.

Although no written analysis has been received from the Public Regulation Commission (PRC),

the Insurance Division of the PRC indicates that:

it is not aware of any specific limitations on medical or dental plan coverage for general an-

esthesia for pediatric dentistry; and

it has received no complaints against insurance carriers for refusal to cover general anesthe-

sia for pediatric dentistry.

ML/mt