S T A T E   O F   N E W   Y O R K
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                                 448--A

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by  M.  of A. GOTTFRIED, GLICK, ORTIZ, PAULIN -- Multi-Spon-
  sored by -- M. of A. BRENNAN, COLTON, COOK, CYMBROWITZ, GANTT, HOOPER,
  JAFFEE, LIFTON, MAGNARELLI, PERRY -- read once  and  referred  to  the
  Committee  on  Health  --  recommitted  to  the Committee on Health in
  accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

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, clause (E-1) as
added by chapter 449 of the laws of 2013, 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

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

                                                           LBD02695-03-6

A. 448--A                           2

  (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
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
  (E-1) the services are vision care services rendered to a student at a
school based health center approved by the commissioner pursuant to this
clause. The commissioner may approve up to five pilot programs at school
based  health  centers  in partnership with a charitable foundation that
agrees to provide free of charge  eyeglass  frames  and  lenses  at  the
centers  pursuant  to  a memorandum of agreement approved by the commis-
sioner. The commissioner may approve  the  rate  for  such  vision  care
services  at  the  rate  for  such services when provided by a federally
qualified health center or when  provided  by  another  entity  licensed
pursuant  to  article twenty-eight of the public health law and eligible
for the ambulatory patient group rate approved for vision care  services
by the commissioner; 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

A. 448--A                           3

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 seventeen.
  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.