S 10606

                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
                                   10606
                             I N  S E N A T E
                               May 29, 2026
                                ___________
 Introduced  by  Sen. ADDABBO -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 AN ACT to amend the insurance  law  and  the  social  services  law,  in
   relation to insurance coverage for bruxism diagnosis and treatment
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
   Section 1. Legislative findings.  The  legislature  hereby  finds  and
 declares that Bruxism is a serious oral health condition that may result
 in  tooth  fracture,  enamel erosion, temporomandibular joint disorders,
 chronic pain, sleep disruption, and irreversible tooth  loss  when  left
 untreated.   Early  diagnosis  and  preventative  treatment  of  bruxism
 substantially reduces the need for costly restorative dental procedures,
 including crowns, implants, dentures, and oral surgery.  Current  dental
 reimbursement   practices   frequently  fail  to  adequately  compensate
 dentists for the evaluation, diagnosis, and treatment  planning  associ-
 ated  with  bruxism and related occlusal disorders, thereby discouraging
 preventative intervention.  Many  dental  insurance  policies  nominally
 provide  coverage for occlusal guards while imposing reimbursement limi-
 tations, utilization barriers, or medical  necessity  requirements  that
 render  such  coverage inaccessible in practice. Low-income individuals,
 Medicaid recipients,  individuals  with  disabilities,  and  underserved
 minority communities disproportionately experience barriers to preventa-
 tive  oral  healthcare  and are more likely to suffer preventable dental
 deterioration and tooth loss due to untreated bruxism. It  is  therefore
 in  the  public  interest  to  promote  preventative  oral healthcare by
 requiring meaningful reimbursement and coverage for  the  diagnosis  and
 treatment of bruxism and related occlusal disorders.
   § 2. Subsection (i) of section 3216 of the insurance law is amended by
 adding a new paragraph 42 to read as follows:
   (42)  (A)  EVERY  POLICY  WHICH PROVIDES COVERAGE OR REIMBURSEMENT FOR
 DENTAL SERVICES SHALL PROVIDE COVERAGE OR REIMBURSEMENT FOR THE  DIAGNO-
 SIS  AND TREATMENT OF BRUXISM AND RELATED OCCLUSAL DISORDERS WHEN DETER-
 MINED TO BE MEDICALLY NECESSARY BY A LICENSED DENTIST.
   (B) SUCH COVERAGE SHALL INCLUDE REIMBURSEMENT FOR:
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD15988-01-6
 S. 10606                            2
   (I) CLINICAL EVALUATION AND SCREENING;
   (II) DIAGNOSIS;
   (III) TREATMENT PLANNING;
   (IV) FOLLOW-UP MONITORING; AND
   (V) CUSTOM-FABRICATED OCCLUSAL GUARDS OR APPLIANCES PRESCRIBED FOR THE
 TREATMENT OF DIAGNOSED BRUXISM OR RELATED OCCLUSAL DISORDERS.
   (C)  NO  INSURER  SHALL  DENY COVERAGE FOR A PRESCRIBED OCCLUSAL GUARD
 SOLELY ON THE BASIS THAT THE TREATMENT IS PREVENTATIVE IN NATURE.
   (D) COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH SHALL NOT BE  SUBJECT
 TO  ANNUAL  OR  LIFETIME  LIMITATIONS THAT ARE LESS FAVORABLE THAN THOSE
 IMPOSED ON OTHER MEDICALLY NECESSARY DENTAL SERVICES.
   (E) THE SUPERINTENDENT OF FINANCIAL SERVICES MAY PROMULGATE RULES  AND
 REGULATIONS  NECESSARY  TO  IMPLEMENT  THE PROVISIONS OF THIS PARAGRAPH,
 INCLUDING  STANDARDS  RELATING  TO  MEDICAL  NECESSITY  AND  UTILIZATION
 REVIEW.
   § 3. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 24 to read as follows:
   (24)  (A)  EVERY GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICY
 ISSUED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES  COVERAGE  OR
 REIMBURSEMENT  FOR  DENTAL SERVICES SHALL PROVIDE COVERAGE OR REIMBURSE-
 MENT FOR THE DIAGNOSIS AND TREATMENT OF  BRUXISM  AND  RELATED  OCCLUSAL
 DISORDERS  WHEN  DETERMINED  TO  BE  MEDICALLY  NECESSARY  BY A LICENSED
 DENTIST.
   (B) SUCH COVERAGE SHALL INCLUDE REIMBURSEMENT FOR:
   (I) CLINICAL EVALUATION AND SCREENING;
   (II) DIAGNOSIS;
   (III) TREATMENT PLANNING;
   (IV) FOLLOW-UP MONITORING; AND
   (V) CUSTOM-FABRICATED OCCLUSAL GUARDS OR APPLIANCES PRESCRIBED FOR THE
 TREATMENT OF DIAGNOSED BRUXISM OR RELATED OCCLUSAL DISORDERS.
   (C) NO INSURER SHALL DENY COVERAGE FOR  A  PRESCRIBED  OCCLUSAL  GUARD
 SOLELY ON THE BASIS THAT THE TREATMENT IS PREVENTATIVE IN NATURE.
   (D)  COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH SHALL NOT BE SUBJECT
 TO ANNUAL OR LIFETIME LIMITATIONS THAT ARE  LESS  FAVORABLE  THAN  THOSE
 IMPOSED ON OTHER MEDICALLY NECESSARY DENTAL SERVICES.
   (E)  THE SUPERINTENDENT OF FINANCIAL SERVICES MAY PROMULGATE RULES AND
 REGULATIONS NECESSARY TO IMPLEMENT THE  PROVISIONS  OF  THIS  PARAGRAPH,
 INCLUDING  STANDARDS  RELATING  TO  MEDICAL  NECESSITY  AND  UTILIZATION
 REVIEW.
   § 4. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (yy) to read as follows:
   (YY)  (1)  EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO-
 RATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH  SERVICE  CORPORATION
 WHICH  PROVIDES  COVERAGE  OR  REIMBURSEMENT  FOR  DENTAL SERVICES SHALL
 PROVIDE COVERAGE OR REIMBURSEMENT FOR THE  DIAGNOSIS  AND  TREATMENT  OF
 BRUXISM  AND  RELATED OCCLUSAL DISORDERS WHEN DETERMINED TO BE MEDICALLY
 NECESSARY BY A LICENSED DENTIST.
   (2) SUCH COVERAGE SHALL INCLUDE REIMBURSEMENT FOR:
   (A) CLINICAL EVALUATION AND SCREENING;
   (B) DIAGNOSIS;
   (C) TREATMENT PLANNING;
   (D) FOLLOW-UP MONITORING; AND
   (E) CUSTOM-FABRICATED OCCLUSAL GUARDS OR APPLIANCES PRESCRIBED FOR THE
 TREATMENT OF DIAGNOSED BRUXISM OR RELATED OCCLUSAL DISORDERS.
   (3) NO INSURER SHALL DENY COVERAGE FOR  A  PRESCRIBED  OCCLUSAL  GUARD
 SOLELY ON THE BASIS THAT THE TREATMENT IS PREVENTATIVE IN NATURE.
 S. 10606                            3
   (4)  COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH SHALL NOT BE SUBJECT
 TO ANNUAL OR LIFETIME LIMITATIONS THAT ARE  LESS  FAVORABLE  THAN  THOSE
 IMPOSED ON OTHER MEDICALLY NECESSARY DENTAL SERVICES.
   (5)  THE SUPERINTENDENT OF FINANCIAL SERVICES MAY PROMULGATE RULES AND
 REGULATIONS NECESSARY TO IMPLEMENT THE  PROVISIONS  OF  THIS  PARAGRAPH,
 INCLUDING  STANDARDS  RELATING  TO  MEDICAL  NECESSITY  AND  UTILIZATION
 REVIEW.
   § 5. Subdivision 2 of section 365-a of  the  social  services  law  is
 amended by adding a new paragraph (f-1) to read as follows:
   (F-1) (I) CARE AND SERVICES FOR THE DIAGNOSIS AND TREATMENT OF BRUXISM
 AND RELATED OCCLUSAL DISORDERS WHEN DETERMINED TO BE MEDICALLY NECESSARY
 BY A LICENSED DENTIST.
   (II) SUCH COVERAGE SHALL INCLUDE REIMBURSEMENT FOR:
   (A) CLINICAL EVALUATION AND SCREENING;
   (B) DIAGNOSIS;
   (C) TREATMENT PLANNING;
   (D) FOLLOW-UP MONITORING; AND
   (E) CUSTOM-FABRICATED OCCLUSAL GUARDS OR APPLIANCES PRESCRIBED FOR THE
 TREATMENT OF DIAGNOSED BRUXISM OR RELATED OCCLUSAL DISORDERS.
   (III)  THE COMMISSIONER MAY PROMULGATE RULES AND REGULATIONS NECESSARY
 TO IMPLEMENT THE  PROVISIONS  OF  THIS  PARAGRAPH,  INCLUDING  STANDARDS
 RELATING  TO  MEDICAL  NECESSITY AND UTILIZATION REVIEW. IN PROMULGATING
 SUCH REGULATIONS, THE COMMISSIONER SHALL PRIORITIZE ACCESS TO  PREVENTA-
 TIVE TREATMENT FOR:
   (A) LOW-INCOME INDIVIDUALS;
   (B) INDIVIDUALS WITH DEVELOPMENTAL OR INTELLECTUAL DISABILITIES;
   (C)  INDIVIDUALS WITH NEUROLOGICAL CONDITIONS ASSOCIATED WITH BRUXISM;
 AND
   (D) COMMUNITIES EXPERIENCING SIGNIFICANT ORAL HEALTH DISPARITIES;
   § 6. 1. The department of health and department of financial  services
 shall  study  the  impact  of  expanded  bruxism diagnosis and treatment
 coverage on:
   a. preventative dental outcomes,
   b. tooth loss prevention,
   c. utilization of restorative dental procedures,
   d. and oral health disparities.
   2. The report required by this  section  shall  be  submitted  to  the
 governor  and  legislature  within  three years of the effective date of
 this act.
   § 7. This act shall take effect on the one hundred eightieth day after
 it shall have become a law and shall apply  to  policies  and  contracts
 issued, renewed, modified, altered or amended on or after such effective
 date.