The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. With respect to a minor, the act also requires that the written informed consent include a specified statement that, among other things, encourages the parent or guardian to explore all the options available for a childs anesthesia for his or her dental treatment.

This bill would revise the required written informed consent statement, applicable for minors, to specify that it is required in the case of general anesthesia. The bill would also revise the content of that statement to require it to include a provision to encourage exploring nonsurgical dental treatment options. options, as specified.

Existing law, the Knox-Keene Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and make a willful violation of that act a crime. Existing law also provides for the regulation of policies of disability insurance by the Insurance Commissioner.

Existing law provides that specified health care service plan contracts and disability insurance policies and certificates are deemed to cover general anesthesia and associated facility charges for dental procedures, upon specified authorization for enrollees or insureds under 7 years of age, enrollees or insureds who are developmentally disabled, or enrolles or insureds whose health is compromised and for whom general anesthesia is medically necessary, if certain other conditions are present. Under existing law, these provisions apply to those procedures rendered in a hospital or surgery center.

This bill, with respect to contracts or policies issued, amended, or renewed on or after January 1, 2019, would remove the language that limits coverage to procedures rendered in a hospital or surgery center.

Because a willful violation of that requirement by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. With respect to a minor, the act also requires that the written informed consent include a specified statement that, among other things, encourages the parent or guardian to explore all the options available for a childs anesthesia for his or her dental treatment.

This bill would revise the required written informed consent statement, applicable for minors, to specify that it is required in the case of general anesthesia. The bill would also revise the content of that statement to require it to include a provision to encourage exploring nonsurgical treatment options.

Existing law, the Knox-Keene Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and make a willful violation of that act a crime. Existing law also provides for the regulation of policies of disability insurance by the Insurance Commissioner.

Existing law provides that specified health care service plan contracts and disability insurance policies and certificates are deemed to cover general anesthesia and associated facility charges for dental procedures, upon specified authorization for enrollees or insureds under 7 years of age, enrollees or insureds who are developmentally disabled, or enrolles or insureds whose health is compromised and for whom general anesthesia is medically necessary, if certain other conditions are present. Under existing law, these provisions apply to those procedures rendered in a hospital or surgery center.

This bill, with respect to contracts or policies issued, amended, or renewed on or after January 1, 2019, would remove the language that limits coverage to procedures rendered in a hospital or surgery center.

Because a willful violation of that requirement by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Date of Hearing: May 16, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2643

Author:(Irwin) – As Amended Ver:April 26, 2018

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill removes facility-based restrictions on health plan and insurer coverage of dental anesthesia, thereby requiring current dental anesthesia coverage to also apply in outpatient settings. (Current law requires coverage in hospitals and surgery centers when it is medically necessary, for children under age seven, and for those with developmental disabilities.)

It also modifies the informed consent form used for general anesthesia in the case of a minor undergoing the procedure.

FISCAL EFFECT:

1. Minor costs to the California Department of Insurance (Insurance Fund) and unknown costs to DMHC likely about $200,000 annually (Managed Care Fund) to verify and enforce health plan and insurer compliance with this requirement.
2. The California Health Benefits Review Program (CHBRP) projects this bill will have the following state costs:
   1. Costs to Medi-Cal managed care of $36 million (GF/federal). This cost is expected to be offset by lower spending in a commensurate amount in the fee-for-service Denti-Cal program, so CHBRP does not predict a net state Medi-Cal cost.
   2. Costs to CalPERS of $2.1 million (GF/federal/special/local).
3. CHBRP projects this bill will have the following non-state costs:
   1. Increased employer-funded premium costs in the private insurance market of approximately $24 million.
   2. Increased premium expenditures by employees and individuals purchasing insurance of $12 million, and reduced individual out-of-pocket costs of $32 million. Many people pay out of pocket for dental anesthesia because they lack of coverage.

COMMENTS:

1. Purpose. The author believes that extending coverage for general anesthesia when provided in dental offices will help remove barriers to dental treatment, ensuring timely care can be provided in the least traumatic setting, with the lowest cost burden for families.
2. Health insurance and dental insurance coverage. Dental insurance plans are not required to cover general anesthesia services, and dental coverage therefore varies by dental policy. Most dental insurance plans cover dental anesthesia for specific procedures performed in a dental office, such as oral surgery.

For enrollees who have both health insurance and dental insurance, the two insurance plans may currently work in conjunction. For instance, a child under age seven who requires general anesthesia for dental procedures may be referred to a hospital or surgical center for treatment. The health insurance will cover the general anesthesia and associated facility charges, while the dental plan will cover the dental work performed by a dentist. Medi-Cal coverage works this way, with managed care plans and dental plans sharing the financial responsibility as described.

Health plans may cover general anesthesia services performed within a dental office, but this is not required by law. This bill would require it for those whose services would otherwise be covered in a hospital setting.

It is now very common for general anesthesia to be performed in an outpatient setting. Dental providers note difficulty securing hospital space to provide dental procedures. CHBRP projected no change in utilization due to provider capacity constraints, but noted utilization could trend upward if more providers because licensed to perform anesthesia.

1. Concern about dental anesthesia safety in young children. High-profile deaths and disabilities in children as a result of dental anesthesia procedures have garnered media attention in recent years. Significant adverse effects from pediatric anesthesia are relatively rare as a percentage of total cases, although they are highly concerning. Any sedation or anesthesia procedure carries some risk of serious side effects. The Dental Board of California (DBC) recently studied the issue to evaluate whether rules governing anesthesia provided in outpatient settings are adequate to protect safety. The board found the rules are generally sufficient, but recommended some changes to enhance personnel requirements. The state Office of Oral Health within the California Department of Public Health indicates preventing severe dental decay in children that necessitates sedation and anesthesia is a critical state priority, but general anesthesia should be provided to children with severe dental decay who cannot otherwise be treated.
2. Support. The California Dental Association (CDA), co-sponsor of this bill, states California has a shortage of hospitals with dental surgery programs that can accept patients who require general anesthesia for dental procedures. They argue this bill will reduce long waits and significant out-of-pocket costs for general anesthesia and that vulnerable patients who need treatment would be able to receive that care in a more accessible and a lower-cost setting. The California Society of Pediatric Dentistry is also a co-sponsor, and the California Association of Oral and Maxillofacial Surgeons and California Society of Anesthesiologists support this bill.
3. Opposition. Health plans and insurers oppose this bill, arguing it is a costly expansion of coverage for services for which health plans and insurers should not be held responsible. The California Chamber of Commerce states that while this bill is well intentioned, employers and individuals are already facing significant increase of their health insurance premiums and that this bill cannot be viewed in isolation.
4. Related Legislation. AB 224 (Thurmond) requires a separate, qualified provider to monitor deep sedation or general anesthesia to children under seven years old; updates the permit structure for minimal, moderate, and deep sedation, and general anesthesia; and updates the definitions of anesthesia. AB 224 is pending in the Senate Business & Professions and Economic Development Committee.

SB 501 (Glazer) is similar to SB 224 and is pending on the Suspense File of this committee.

1. Prior Legislation. AB 2235, Thurmond, Chapter 519, Statutes of 2016, required the DBC, on or before March 31, 2017, to establish a committee to investigate current laws and regulations for the use of pediatric anesthesia in dentistry.
2. Staff Comments. This bill changes the way dental anesthesia is paid for through the Medi-Cal program by requiring managed care plans to cover a service currently covered by Denti-Cal. Since this will not expand coverage, but simply change who pays for it, the author may wish to consider the necessity of this change.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 24, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2643

Author:(Irwin) – As Introduced Ver:February 15, 2018

SUBJECT: Dentistry: general anesthesia: health care coverage.

SUMMARY: Requires, health care (health plan) contracts, other than a specialized service plan as defined, and disability insurance policies or certificates covering hospital, surgical or medical expenses, to cover general anesthesia and associated facility charges for dental procedures when the clinical status or underlying medical condition of the enrollee or insured requires dental procedures that ordinarily would not require general anesthesia. Specifically, this bill:

1. Requires every health plan contract, other than a specialized service plan contract, to cover general anesthesia and associated facility charges for dental procedures when the clinical status or underlying medical condition of the patient requires dental procedures that ordinarily would not require general anesthesia. Removes the requirement that such services may only be rendered in a hospital or surgery center setting.
2. Applies 1) above to a disability insurance policy or certificate covering hospital, surgical, or medical expenses, that meets the definition of “health benefit plan” to cover general anesthesia and associated facility charges for dental procedures when the clinical status or underlying medical condition of the insured requires dental procedures that ordinarily would not require general anesthesia. Removes the requirements that such services may only be rendered in a hospital or surgery center setting.
3. Applies to health plan contracts or insurance policies issued, amended, renewed, delivered on or after January 1, 2019
4. Allows health care service plans and disability insurance policies to include coverage specified in 1) and 2) above prior to January 1, 2019.
5. Revises the specific language requirement for written informed consent to apply only to general anesthesia, not conscious sedation, and adds a phrase to the required language so that it reads in part:

“You are encouraged to explore all the options available for your child’s anesthesia for his or her dental treatment, including nonsurgical treatment options, and consult with your dentist or pediatrician as needed “

EXISTING LAW:

1. Establishes the Department of Managed Health Care (DMHC) to regulate health plans and establishes the Department of Insurance (CDI) to regulate health insurers.
2. Establishes the Dental Board of California (DBC) to regulate the practice of dentistry including the administration of conscious sedation or general anesthesia by a person licensed under their jurisdiction.
3. Defines a health benefit plan as any group or individual policy of health insurance that provides coverage for hospital, medical or surgical benefit.
4. Requires health plan contracts, other than a specialized health plan, and specified disability insurance policies or certificates to cover general anesthesia and associated facility charges for dental procedures rendered in a hospital or surgery center setting when the clinical status or underlying medical condition of the patient requires dental procedures that ordinarily would not require general anesthesia.
5. Limits the general anesthesia and associated facility charges benefits described in 4) above to only enrollees and insureds who meet the criteria described in 4) above and:
   1. Are under seven years of age;
   2. Are developmentally disabled, regardless of age; and,
   3. Whose health is compromised and for whom general anesthesia is medically necessary, regardless of age.
6. Requires a dentist, prior to administering or ordering the administration of general anesthesia on an outpatient basis for dental patients to meet one of the following criteria:
   1. Possess a current license in good standing to practice dentistry in California and hold a valid general anesthesia permit issued by the DBC;
   2. Possess a current Oral and Maxillofacial Surgery permit issued by the DBC and hold a valid general anesthesia permit issued by the DBC; or,
   3. Possess a current Special Permit issued by the DBC and hold a valid general anesthesia permit issued by the DBC.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, much has changed since 1988 when health plan coverage of general anesthesia in hospitals and surgery centers for these special populations was required. It is now very common for this care to be provided in dental offices where cost is significantly less, wait times for appointments are much shorter, and the duration of anesthesia shorter. The author believes that extending coverage for general anesthesia when provided in dental offices will help remove barriers to dental treatment, ensuring timely care can be provided in the least traumatic setting, with the lowest cost burden for families.
2. BACKGROUND.
   1. Indications for the Use of Dental General Anesthesia (DGA) in Treating Children and Adults with Special Needs. General anesthesia involves the administration of sedative drugs to render a patient completely unconscious and unresponsive to stimuli, including pain, in order to perform certain medical procedures. There are three main reasons why children age zero to six or adults with special needs may require DGA:

i) advanced oral conditions requiring extensive surgical intervention that cannot be done with lighter forms of sedation or local anesthetic: ii) when the patient is allergic to local anesthetics; and, iii) when the dentist determines that the patient is unable to undergo any dental procedure that requires them to remain still so that the dentist can perform the procedure without injuring the patient, even with lighter forms of sedation. In the case of iii) above, DGA is used as a form of behavioral management to ensure the safety of the patient and may be used for even routine types of dental care and treatment (e.g., cleanings) depending on the level of impairment and based on the dentists’ best judgement of the patient’s needs. Increasing levels of sedation are used as a type of behavioral management in dentistry; alternative behavioral management techniques that may be utilized with or without sedation include protective stabilization with physical restraints or by parents holding children, positive reinforcement, or distraction.

1. Interaction between Health Insurance and Dental Insurance Coverage in California. Dental insurance plans are not required to cover general anesthesia services and therefore dental coverage of DGA varies by dental policy. Most dental insurance plans cover DGA for specific procedures performed in a dental office, such as oral surgery. For enrollees who have both health insurance and dental insurance, the two insurance plans may currently work in conjunction, as follows: a child under age seven who requires general anesthesia for dental procedures may be referred to a hospital or surgical center for treatment. The health insurance will cover the general anesthesia and associated facility charges, while the dental plan will cover the dental work performed by a dentist. When general anesthesia services are performed within a dental office and covered by health insurance, the dental office or patient will be responsible for billing the patient’s health insurance. Some dentists may choose to require patients to pay out of pocket for general anesthesia services, in which case the patients (or caregiver) would be responsible for filling a reimbursement claim with the health insurance company.
2. California Health Benefits Review Program (CHBRP) analysis. AB 1996 (Thomson), Chapter 795, Statutes of 2002, requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandate legislation. CHBRP was created in response to AB 1996. SB 125 (Hernandez), Chapter 9, Statutes of 2015, added an impact assessment on essential health benefits, and legislation that impacts health insurance benefit designs, cost sharing, premiums, and other health insurance topics. CHBRP states in its analysis of this bill the following:
   • 1. Enrollees covered. CHBRP estimates that, in 2019, 100% of the 23.4 million Californians enrolled in state-regulated health insurance will have insurance subject to this bill.
     2. Impact on expenditures. This bill would increase total net annual expenditures by $42,819,000, or 0.0275%, for enrollees with DMHC-regulated plans and CDI-regulated policies. This is due to an $80,413,000 increase in total health insurance premiums paid by employers and enrollees for newly covered benefits, adjusted by a decrease of $37,594,000 in enrollee expenses for covered and/or non-covered benefits.
        1. Premium increases in privately funded DMHC-regulated plans range from $0.1835 per member per month (PMPM) for individual plans to $0.2159 PMPM for large-group plans. Among CDI-regulated policies, premium increases range from $0.0122 PMPM for large-group policies to $0.1873 PMPM for individual policies. After offsetting decreases in enrollee expenses for non-covered benefits, premium increases in privately funded DMHC-regulated plans or CDI-regulated policies range from 0.0002% for CDI-regulated large-group policies to 0.0065% for CDI-regulated individual policies. Expenditures for CalPERS are expected to increase by $2,121,000 or 0.04% in 2019. Premiums are projected to increase by $0.2317 PMPM.
        2. Expenditures paid for by Medi-Cal Managed Care (MCMC) plans are expected to increase by $36,363,000, or 0.12%, in 2019. Although Medi-Cal enrollees do not pay premiums, PMPM “premiums” would increase by $0.4035. As discussed above, since utilization is not expected to increase in the first year post-mandate, costs for DGA are shifting from Denti-Cal to MCMC plans.
        3. Expenditures for CalPERS ae expected to increase by $2,121,000 or 0.04% in 2019. Premiums are projected to increase by $0.2317 PMPM.
        4. Because the change in average premiums does not exceed 1% for any market segment, CHBRP would expect no measurable change in the number of uninsured persons due to the enactment of this bill.
     3. EHBs. Because this bill amends the locations for which this service is covered, it would not require coverage for a new state benefit mandate and appears not to exceed the definition of EHBs in California.
     4. Medical effectiveness. CHBRP found limited evidence that procedures involving DGA in office-based settings are less safe and effective than those provided in hospitals or surgery centers. General anesthesia (as opposed to lesser levels of sedation) is more commonly used in youth and children for routine procedures, such as the treatment of dental caries, than in adults. This is also true for persons of all ages with special needs, such as mental or physical disabilities, or those requiring DGA due to medical necessity. For these populations, the outcomes related to receiving dental surgery without DGA (safety issues, treatment efficacy) could potentially be affected. Treatment under other forms of anesthesia that do not render the patient unresponsive to physical stimuli may not adequately control patient movement, or may require patient cooperation and adherence to instructions that is beyond the ability of young children or adults with special needs. CHBRP found inconclusive evidence that receiving dental surgery under conscious sedation versus DGA could affect outcomes. Although there are numerous alternative treatments available for some routine dental procedures (such as preventative measures or routine cleanings) that may require no or minimal sedation for the general population, the literature review revealed no proven alternative options for the comprehensive treatment of most problems that require DGA (such as tooth infection or decay to the degree requiring extraction), especially for populations such as very young children or children and adults with special needs. CHBRP found insufficient evidence that there are effective alternate treatments for young children or special needs populations for which DGA or any type of sedation is not needed. It is possible that in cases where coverage for DGA is not available in the dental office for required dental procedures, patients (or parents or caregivers of patients) may forgo care. CHBRP found a preponderance of evidence that lack of treatment for conditions such as dental caries can lead to secondary complications that could impact dental and overall health.

Prior to administering DGA or performing other dental procedures on a child, parents or caregivers must be administered an informed consent document and a provider must explain the procedure, why it is recommended, the benefits, and risks to parents so that they can decide whether or not to allow the child to be treated. There is limited evidence that informed consent forms are not thoroughly read or understood by parents/caregivers of pediatric patients or patients with special needs. CHBRP found no studies examining the impact of new language to the informed consent form with regard to patient or caregiver/parent decision making, and therefore concludes there is insufficient evidence to that the addition of new wording to the informed consent form would impact patient choice of treatment or service utilization.

• • 1. Benefit coverage. Currently, 6% of enrollees with health insurance that would be subject to this bill have medical coverage for DGA that takes place in any location. Post-mandate, CHBRP estimates that coverage will increase to 100% of enrollees in DMHC-regulated plans or CDI-regulated policies. This would increase the number of enrollees with coverage compliant with this bill from 1.5 million at baseline to the full 23.4 million enrolled in DMHC-regulated plans or CDI-regulated policies, post-mandate. However, the number of enrollees eligible for health insurance coverage of DGA is limited to the populations stated above, and is therefore substantially smaller than 23.4 million enrollees.
    2. Utilization. CHBRP estimates a total of 124,000 enrollees currently utilize DGA in any location. This population is comprised of 60,000 enrollees in MCMC plans and 64,000 enrollees in commercial plans and policies. During the first year post-mandate, CHBRP estimates no increase in total utilization for all populations, based on provider supply constraints and that DGA is used in cases of medical necessity. Currently, 0.37 per 1,000 enrollees in commercial plans or policies, and 1.45 per 1,000 enrollees in DMHC-regulated MCMC plans use DGA in a hospital or surgical center setting. CHBRP estimates that this prevalence rate will not change post-mandate as this bill does not increase coverage for general anesthesia for dental procedures in these locations. Currently, there are 3.63 per 1,000 enrollees in commercial plans or policies, and 6.55 per 1,000 enrollees in MCMC plans that use DGA in dental offices, with limited health insurance coverage for these locations. While enrollees in commercial plans or policies pay for DGA in a dental office out-of-pocket, enrollees in MCMC plans have coverage for DGA through Denti-Cal. CHBRP estimates that in the first year post-mandate, utilization of DGA in a dental office will remain the same due to supply constraints, but that the utilization will shift from being covered through out-of-pocket expenditures or Denti-Cal, to being covered through DMHC-regulated plans or CDI-regulated policies. Therefore, utilization covered through DMHC-regulated plans or CDI-regulated policies will increase post-mandate by 3.63 per 1,000 enrollees in commercial plans or policies, and by 6.55 per 1,000 enrollees in MCMC Plans.
    3. Public health. According to CHBRP, in the first year post-mandate, because no change or shift in utilization is estimated, CHBRP estimates that coverage of DGA in office-based settings for pediatric and special needs populations will have no public health impact. However, there will be a reduction in financial burden on enrollees who would have paid for non-covered DGA out of pocket pre-mandate and would obtain DGA as a covered benefit post-mandate.

In the first year post-mandate, there will be no public health impact of this bill regarding adding text to the parental informed consent to explore nonsurgical treatment options on decisions about children receiving DGA due to insufficient evidence that changing the language would impact parents’ decisions and consequently no estimated change in utilization or coverage.

• • 1. Long-term impacts. Over the long term, CHBRP estimates that utilization of DGA will remain similar to the one-year post-mandate estimates of 2019, given the provider constraints on supply of DGA. However, the post-mandate coverage under this bill may encourage more dental providers to become licensed in DGA and to perform the service in a dental office, which would loosen the supply constraints. While overall utilization of DGA would still be constrained by medical necessity, the current waitlists could be shortened, and more instances of DGA could occur within a one-year timeframe. Despite a stable reduction in financial burden, there will be no long- term public health impacts. However, it stands to reason that given the increase in coverage, especially for privately insured enrollees, in the longer term as out-of-pocket costs are reduced, demand for DGA may increase, and more dental professionals may become DGA-certified and offer DGA at their office-based practices as they will now be able to be reimbursed for the service by insurance, increasing the supply of DGA professionals; the lack thereof is the limiting factor preventing any forecasted increase or shift in DGA utilization over time.
  1. Other States. Thirty other states have laws mandating health insurance coverage of general anesthesia for dental procedures. As of 2012, six states had laws stating DGA was covered in locations other than a hospital, such as a dental office or rural clinic. Two additional states mandate health insurance coverage of general anesthesia for dental procedures but do not specify location where services are provided.

1. SUPPORT. The California Dental Association (CDA), co-sponsor of this bill states that California has long had a shortage of hospitals with dental surgery programs that can accept patients who require general anesthesia for dental procedures. 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. CDA concludes by stating that under this bill, vulnerable patients who need general anesthesia for their dental treatment would be able to receive that care in a more accessible and a lower cost setting. The California Society of Anesthesiologists states that this bill would expand access to care and reduce cost by enabling more extensive procedures requiring general anesthesia to be performed in the cost-effective setting of the dental office.
2. OPPOSITION. The California Association of Health Plans states in opposition to this bill, that this is the wrong time to pass more mandates. California’s employers, workers, and families benefit from a competitive and relatively stable commercial marketplace. The relative stability of market is fortified by a broad and diverse base of enrollment that balances the overall cost of care. Coverage mandates do not help maintain that delicate balance. CalChamber states that while this bill is well intentioned, employers and individuals are already facing significant increase of their health insurance premiums and that this bill cannot be viewed in isolation. There are a number of other health care bills that would increase health care cost adding more pressure to increase health care premiums.
3. RELATED LEGISLATION.
   1. AB 224 (Thurmond) requires a separate, qualified anesthesia provider to administer deep sedation or general anesthesia to children under seven years old; updates the permit structure for minimal, moderate, and deep sedation, and general anesthesia; and updates the definitions of anesthesia. AB 224 is pending in the Senate Business & Professions and Economic Development Committee.
   2. SB 392 (Bates) requires the DBC to provide to the Legislature a report and analysis, as specified, of the effects on access to care for pediatric dental patients specifically as it relates to requiring the addition of a 2nd general anesthesia permit holder to be present during the administration of general anesthesia on a patient 7 years of age or younger, if the provider is currently a general anesthesia permit holder. AB 392 is pending in the Assembly Committee on Business and Professions.
4. PREVIOUS LEGISLATION. AB 2235, Thurmond, Chapter 519, Statutes of 2016, required the DBC, on or before March 31, 2017, to establish a committee to investigate current laws and regulations for the use of pediatric anesthesia in dentistry.
5. SUGGESTED AMENDMENTS: In an effort to fully capture the author’s intent, the provision which clarifies the required statement, should apply only to general anesthesia and not conscious sedation, and as such the language relating the general anesthesia written informed consent should read as follows:

(2) The written informed consent for general anesthesia, in the case of a minor, shall

include, but not be limited to, the following information:

“The administration and monitoring of general anesthesia may vary depending on the type or procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for his or her dental treatment and consult with your dentist or pediatrician as needed. You are further encouraged to consult with your dentist on all of the non-surgical dental treatment options available that may reduce, delay or eliminate the need for anesthesia for surgical dental treatment prior to granting this consent.”

REGISTERED SUPPORT / OPPOSITION:

Support

California Dental Association (cosponsor)

California Society of Pediatric Dentistry (cosponsor)

California Association of Oral and Maxillofacial Surgeons

California Society of Anesthesiologists

Opposition

America’s Health Insurance Plans

Association of California Life and Health Insurance Companies

California Association of Health Plans

California Chamber of Commerce

Local Health Plans of California

Analysis Prepared by: Kristene Mapile and Judith Babcock / HEALTH / (916) 319-2097