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

SPONSOR SCORC

ORIGINAL DATE

LAST UPDATED

3/05/07

HB

SHORT TITLE Dental Surgery Insurance Coverage

SB 776/SCORCS

ANALYST Earnest

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY07

FY08

NFI

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Public Regulation Commission (PRC)

Human Services Department (HSD)

Public Education Department (PED)

SUMMARY

Synopsis of Bill

The Senate Corporations and Transportation Committee (SCORC) substitute for Senate Bill 776

would add new sections to the Health Care Purchasing Act and the Insurance Code to require

group health care coverage plans, certificates of health insurance, and group health maintenance

organizations, including any form of self-insurance, to provide coverage for general anesthesia

and hospitalization for dental surgery under certain conditions.

This provision would not apply to short-term travel, accident-only or limited or specified disease

policies. Coverage could be subject to deductibles and coinsurance consistent with those

imposed on other benefits.

FISCAL IMPLICATIONS

None identified.

SIGNIFICANT ISSUES

The bill lists five conditions for which insurers must cover general anesthesia and hospitalization

Senate Bill 776/SCORCS – Page

2

for dental surgery:

1.

insured patients exhibiting physical, intellectual or medically compromising conditions for

which dental treatment under local anesthesia cannot be expected to provide a successful

result and for which dental treatment under general anesthesia can be expected to produce

superior results;

2.

insured patients for whom local anesthesia is ineffective because of acute infection, anatomic

variation or allergy;

3.

insured children or adolescents who are extremely uncooperative, fearful, anxious or

uncommunicative 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;

4.

insured patients with extensive oral-facial or dental trauma for which treatment under local

anesthesia would be ineffective or compromised; or

5.

other procedures for which hospitalization or general anesthesia in a hospital or ambulatory

surgical center is medically necessary.

The State of New Mexico dental plan administered by Delta Dental covers general anesthesia.

Hospitalization would be covered by the State of New Mexico’s insurance plans.

PRC notes that the bill excludes short-term travel, accident-only or limited or specified disease

policies, thus exempting dental-only plans from its provisions. In effect, dental plans would not

have to comply with this mandate

ADMINISTRATIVE IMPLICATIONS

The bill may require some insurers to re-file policy forms and rates with the PRC’s Insurance

Division to comply with this law. The Insurance division believes that current staff can handle

the additional work without fiscal or performance implications.

BE/mt