Committee hears SB268 to align insurance reimbursement with public‑health dental hygienist law; dental groups raise diagnostic concerns

Sen. Edgar Flores (D‑District 2) and representatives of the nonprofit Future Smiles presented Senate Bill 268 to the Commerce and Labor Committee, saying the measure would align insurance reimbursement practices with existing law that allows public‑health endorsed dental hygienists to provide certain services without a dentist present.

"SB 268 will align NRS 631.287 which is the section for our Dental Hygiene Public Health Endorsement and NRS 689A under the insurance commissioner," said Terri Chandler, executive director of Future Smiles. Chandler described the organization’s school‑based mobile program, the CDT procedure codes used (including D0190 oral health screening, D1206 fluoride varnish, D1351 sealants, D120N110 prophylaxis) and its case‑management work to find dental homes for children. Chandler said Future Smiles serves largely low‑income families; she told the committee that about 50 percent of the children they see are on Medicaid, 40 percent uninsured and about 10 percent have private dental insurance.

Sen. Flores and Future Smiles said insurers have denied legitimate claims on the ground that the services were provided without a dentist present, despite the existing statutory endorsement. Warren Hardy and Future Smiles representatives said the bill does not expand the scope of practice; it simply prevents insurers from denying payment for services the statute authorizes. "We're looking to get paid for services that we legally provide under the statute so that the taxpayers don't have to and so that our philanthropists and donors don't have to," Hardy told the committee.

Opposition testimony came from the Nevada Dental Association and the Nevada Dental Association (NDA) leadership, represented by Eddie Ableser (TriStrategy), Dr. Amy Abbatan (vice president, Nevada Dental Association) and Mariana Kacyra (executive director, NDA). Opponents argued that submitting insurance claims using CDT codes requires an accompanying dental diagnosis that, under existing law and professional standards, must come from a dentist following an examination. Dr. Abbatan said, "Submission of claims to insurances utilizing CDT ... requires a formal dental diagnosis, which must be made during an examination with the dentist. ... Dental hygienists are not statutorily able to provide that diagnosis on their own." NDA expressed concerns about patient safety, inconsistent diagnostic standards and potential insurance‑claim invalidity.

Chandler and Hardy said Future Smiles obtains parental consent, collects insurance information on consent forms, refers higher‑level care to dentists and uses case managers to navigate follow‑up care. Chandler said the nonprofit also receives grant funding and works with UNLV School of Dental Medicine and volunteer dentists. Hardy said the Division of Health and Human Services grant program already funds some expansion and that the Division of Insurance indicated it would remove a fiscal note because Medicaid already provides many of the services.

Delta Dental and the city of North Las Vegas provided support or neutral testimony; the Division of Insurance confirmed it would not anticipate triggering federal defray provisions by allowing additional providers to submit claims but said scope‑of‑practice and standard‑of‑care questions are not generally within its expertise.

Committee members asked for clarifying conversations between Future Smiles and the dental associations; Sen. Flores said he would convene a working group and invite Legislative Counsel Bureau legal counsel to clarify intent and statutory alignment. The committee did not take a final vote on SB268 during the hearing.