CDA, CSPD, sponsor bill to expand health plan coverage for dental anesthesia

A bill introduced in the state Legislature in February could, if enacted, improve access to and reduce the cost of dental services performed under general anesthesia for some individuals when certain conditions are met.

Assembly Bill 2643 (Irwin, D-Thousand Oaks), co-sponsored by CDA and the California Society of Pediatric Dentistry, would require medical insurance plans to cover general anesthesia costs in the dental office setting when a patient’s developmental or other physical condition prevents that patient from receiving dental treatment unless deeply sedated but does not necessitate a hospital setting for care.

Specifically, AB 2643 amends Section 1367.1 of the Health and Safety Code and Section 10119.9 of the Insurance Code to remove the language that limits general anesthesia coverage for dental procedures to those only performed in a hospital or surgery center setting. This would only apply to new plans sold as of Jan. 1, 2019.

“By expanding existing medical plan coverage for dental anesthesia to all settings, including in-office, this bill will help to address access and cost concerns,” said John Blake, DDS, CDA Government Affairs Council chair.

California has long had a shortage of hospitals with dental surgery programs that can accept patients who require general anesthesia for dental procedures. Several years ago, the state’s northern region temporarily lost its last partnering hospital when Sutter Medical Center closed its dental surgery program with little notice. An urgently convened meeting between Sutter and community health advocates led to talks that stopped the closure, but today the waits for dental surgery in hospitals are still long — often up to two years.

Long waits or the absence of a nearby hospital or surgery center force many individuals to choose between delaying needed dental care or having their procedures performed under general anesthesia in the dental office without the benefit of coverage. This limitation leaves patients paying significant out-of-pocket costs for general anesthesia. AB 2643 would change this.

“Time and cost affect access, and we’re trying with this bill to make sure needed dental services are more accessible,” Blake said. He added that while many individuals do require care in the hospital setting, many others are not cooperative in the chair but are healthy enough to receive dental care under general anesthesia in the dental office. They would be able to do so with medical coverage under this bill.

“Pediatric dentists know this need,” said Paul Reggiardo, DDS, public policy advocate for the California Society of Pediatric Dentistry. “They have been providing dental care under general anesthesia in their offices, safely and effectively, for many years now. It is appropriate for these costs to be borne by medical insurance plans regardless of the setting.”

For the new coverage requirement to apply, the dental patient, specified as the medical plan enrollee, must meet one of three criteria: be under age 7, be developmentally disabled at any age or be of any age with physical or medical conditions that require general anesthesia for the provision of dental care.

Clarification for required informed consent

AB 2643 addresses two other concerns. First, it would revise the required written informed consent language for dental anesthesia for minors to reference nonsurgical treatment options.

The rationale for revising the informed consent language, said Blake, is to ensure that as silver diamine fluoride, interim therapeutic restorations and other alternative treatments for dental caries become available, patients are engaging in thorough discussions about these options before choosing to undergo general anesthesia for their dental treatment. (Read articles on the use of silver diamine fluoride in the January and February 2018 issues of the CDA Journal.)

Second, the bill provides a technical “fix” in the general anesthesia-specific informed consent statement required by Section 1682 of the Business and Professions Code. As this section addresses dental procedures performed under both general anesthesia and conscious sedation, the revised language clarifies that the specified informed consent statement is required only for general anesthesia.

The bill is expected to be heard in late April by the Assembly Health Committee.

CDA will keep members informed about the bill’s status on cda.org and in the CDA Update.

Related Items

New legislation sponsored by CDA and introduced by Sen. Nancy Skinner (D-Berkeley) is working to increase value and transparency of dental benefit plans. Senate Bill 1008 calls for the establishment of a minimum dental loss ratio for individual, small and large group dental benefit products and requires increased transparency for consumers who purchase dental savings or dental discount products by requiring standardized disclosures of what a dental benefit plan does or does not provide.

Students representing California dental schools traveled to Sacramento in February to meet with legislators and their staff, tour the Capitol building and learn how to advocate as part of Grassroots Advocacy Days. CDA hosts the day-long events every year to give students an opportunity to meet with their district representatives to discuss critical issues affecting dentistry.