SENATE BILL No. 984

February 9, 2000, Introduced by Senators STILLE, BYRUM, SCHWARZ, SHUGARS, HAMMERSTROM, NORTH and ROGERS and referred to the Committee on Health

Policy.

A bill to amend 1984 PA 218, entitled

"Third party administrator act,"

(MCL 550.901 to 550.962) by adding section 33a.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

1 SEC. 33A. (1) A TPA SHALL NOT ENTER INTO A SERVICE CONTRACT

2 TO ADMINISTER A PLAN UNLESS THE PLAN INCLUDES COVERAGE FOR GEN-

3 ERAL ANESTHESIA AND ASSOCIATED FACILITY CHARGES FOR DENTAL PROCE-

4 DURES RENDERED IN A HOSPITAL OR SURGICAL CARE SETTING IF ALL OF

5 THE FOLLOWING ARE MET:

6 (A) THE CLINICAL STATUS OR UNDERLYING MEDICAL CONDITION OF

7 THE PATIENT, AS DETERMINED BY THE PATIENT'S PRIMARY CARE PHYSI-

8 CIAN, PEDIATRICIAN, OR DENTIST, REQUIRES DENTAL PROCEDURES THAT

9 ORDINARILY WOULD NOT REQUIRE GENERAL ANESTHESIA TO BE RENDERED IN

10 A HOSPITAL OR SURGICAL CARE SETTING.

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1 (B) THE PATIENT MEETS 1 OR MORE OF THE FOLLOWING:

2 (i) IS UNDER 7 YEARS OF AGE.

3 (ii) IS DEVELOPMENTALLY DISABLED, REGARDLESS OF AGE.

4 (iii) HAS HEALTH THAT IS COMPROMISED AND FOR WHOM GENERAL

5 ANESTHESIA REGARDLESS OF AGE IS MEDICALLY NECESSARY AS DETERMINED

6 BY THE PATIENT'S PRIMARY CARE PHYSICIAN, PEDIATRICIAN, OR

7 DENTIST.

8 (2) PRIOR AUTHORIZATION OF GENERAL ANESTHESIA AND ASSOCIATED

9 FACILITY CHARGES FOR DENTAL CARE PROCEDURES MAY BE REQUIRED IN

10 THE SAME MANNER THAT PRIOR AUTHORIZATION IS REQUIRED FOR OTHER

11 COVERED BENEFITS. COVERAGE FOR ANESTHESIA AND ASSOCIATED FACIL-

12 ITY CHARGES UNDER THIS SECTION IS SUBJECT TO ALL OTHER TERMS AND

13 CONDITIONS OF THE PLAN THAT APPLY GENERALLY TO OTHER BENEFITS.

14 (3) THIS SECTION DOES NOT REQUIRE COVERAGE FOR THE DENTAL

15 PROCEDURE ITSELF, INCLUDING, BUT NOT LIMITED TO, THE DENTIST'S

16 PROFESSIONAL FEE.

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