§ 27-13-7-15 — Dental care provisions required

(a) As used in this section, "child" means an
individual who is less than nineteen (19) years of age.
(b) As used in this section, "enrollee" means an enrollee who is a
child or an individual:
(1) with a physical or mental impairment that substantially limits
one (1) or more of the major life activities of the individual; and
(2) who:
(A) has a record of; or
(B) is regarded as;
having an impairment described in subdivision (1).
(c) A health maintenance organization that provides basic health
care services shall include coverage under the terms and conditions of
the benefits contract for anesthesia and hospital charges for an enrollee
for dental care if the mental or physical condition of the enrollee
requires dental treatment to be rendered in a hospital or an ambulatory
outpatient surgical center. The Indications for General Anesthesia, as
published in the reference manual of the American Academy of
Pediatric Dentistry, are the utilization standards for determining
whether performing dental procedures necessary to treat the enrollee's
condition under general anesthesia constitutes appropriate treatment.
(d) A health maintenance organization may:
(1) require prior authorization for hospitalization or treatment in
an ambulatory outpatient surgical center for dental care
procedures in the same manner that prior authorization is required
for hospitalization or treatment of other covered medical
conditions; and
(2) restrict coverage to include only procedures performed by a
licensed dentist who has privileges at the hospital or ambulatory
outpatient surgical center.
(e) This section does not apply to treatment rendered for temporal
mandibular joint disorders (TMJ).

Legislative History

As added by P.L.189-1999, SEC.3.