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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.
pg_0002
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