S T A T E   O F   N E W   Y O R K
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                                  5346

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            February 25, 2013
                               ___________

Introduced  by  M. of A. GOTTFRIED, GLICK, CLARK, JACOBS, ORTIZ, PAULIN,
  BROOK-KRASNY, V. LOPEZ -- Multi-Sponsored by  --  M.  of  A.  BRENNAN,
  COLTON,  COOK,  CYMBROWITZ, GANTT, HOOPER, JAFFEE, LIFTON, MAGNARELLI,
  MILLMAN, WEISENBERG -- read once and  referred  to  the  Committee  on
  Health

AN  ACT  to  amend  the  social services law, in relation to requiring a
  managed care program to establish  procedures  through  which  partic-
  ipants will be assured access to medical assistance dental services to
  which they are otherwise entitled, other than through the managed care
  provider

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subparagraph (iii) of paragraph (a)  of  subdivision  4  of
section  364-j  of  the social services law, as amended by section 14 of
part C of chapter 58 of the laws of 2004, clause (E) as added and clause
(F) as relettered by chapter 37 of the laws of 2010, is amended to  read
as follows:
  (iii)  under  a  managed  care program, not all managed care providers
must be required to provide the same set of medical assistance services.
The managed  care  program  shall  establish  procedures  through  which
participants  will  be assured access to all medical assistance services
to which they are otherwise entitled, other  than  through  the  managed
care provider, where:
  (A)  the  service  is  not reasonably available directly or indirectly
from the managed care provider,
  (B) it is necessary because of emergency or geographic unavailability,
or
  (C) the services provided are family planning services; or
  (D) the services PROVIDED are dental services [and are provided  by  a
diagnostic  and  treatment center licensed under article twenty-eight of
the public health law which is affiliated with an academic dental center
and which has been granted an operating certificate pursuant to  article
twenty-eight  of  the public health law to provide such dental services.
Any diagnostic and treatment center providing dental  services  pursuant

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01214-01-3

A. 5346                             2

to  this  clause  shall  prior  to June first of each year report to the
governor, temporary president of the senate and speaker of the  assembly
on  the following: the total number of visits made by medical assistance
recipients during the immediately preceding calendar year; the number of
visits  made  by  medical  assistance  recipients during the immediately
preceding calendar year by recipients who were enrolled in managed  care
programs;  the  number  of  visits made by medical assistance recipients
during the immediately preceding calendar year by  recipients  who  were
enrolled  in  managed  care  programs  that provide dental benefits as a
covered service; and the number of visits made by the  uninsured  during
the immediately preceding calendar year]; or
  (E)  the  services  are optometric services, as defined in article one
hundred forty-three of the education law, and are provided by a diagnos-
tic and treatment center licensed  under  article  twenty-eight  of  the
public  health  law which is affiliated with the college of optometry of
the state university of New York and which has been granted an operating
certificate pursuant to article twenty-eight of the public health law to
provide such optometric services. Any diagnostic  and  treatment  center
providing  optometric  services  pursuant  to this clause shall prior to
June first of each year report to the governor, temporary  president  of
the  senate  and  speaker  of  the assembly on the following:  the total
number of visits made by medical assistance recipients during the  imme-
diately  preceding  calendar  year; the number of visits made by medical
assistance recipients during the immediately preceding calendar year  by
recipients  who  were  enrolled  in managed care programs; the number of
visits made by medical  assistance  recipients  during  the  immediately
preceding  calendar year by recipients who were enrolled in managed care
programs that provide optometric benefits as a covered service; and  the
number  of visits made by the uninsured during the immediately preceding
calendar year; or
  (F) other services as defined by the commissioner of health.
  S 2. The department of health shall analyze and compare  expenditures,
utilization  rates  and  utilization patterns for dental services (along
with any related effects on expenditures, rates and patterns  for  other
services) for medical assistance recipients; for the period during which
medical  assistance  reimbursement for such services was included in the
state rate of payment for medicaid  managed  care  and  for  the  period
beginning  with  the  date on which medical assistance reimbursement for
such services was no longer included in the state rate  of  payment  for
medicaid managed care.
  The  department  of  health  shall include in its analyses and compar-
isons, the expenditures, utilization rates and utilization patterns  for
dental  services  (along with any related effects on expenditures, rates
and patterns for other services) paid for by private third-party payors.
  The department of health shall report its findings  to  the  governor,
the temporary president of the senate and the speaker of the assembly by
December first, two thousand fourteen.
  S 3. This act shall take effect on the one hundred twentieth day after
it  shall  have  become a law, provided, however, that the amendments to
subparagraph (iii) of paragraph (a) of subdivision 4 of section 364-j of
the social services law made by section one of this act shall not affect
the repeal of such section, as provided by section 11 of chapter 710  of
the  laws of 1988, as amended, and shall be deemed to be repealed there-
with.