NY State Senate Bill 2015-S717A

Senate Bill S717A

2015-2016 Legislative Session

Requires managed care programs to establish procedures to assure participant access to dental services to which entitled, other than through managed care provider

download bill text pdf

Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 13, 2016	print number 717a
Jan 13, 2016	amend and recommit to health
Jan 06, 2016	referred to health
Jan 07, 2015	referred to health

Bill Amendments

Original

A (Active)

2015-S717 - Details

See Assembly Version of this Bill:: A448
Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A1720
2011-2012: A1539
2013-2014: S5894, A5346

2015-S717 - Summary

Requires managed care programs to establish procedures to assure participant access to medical assistance dental services to which they are otherwise entitled, other than through the managed care provider.

2015-S717 - Sponsor Memo

2015-S717 - Bill Text download pdf

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

                                   717

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
  printed to be committed 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, 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
  (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.

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

                                                           LBD02695-01-5

S. 717                              2

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
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

S. 717                              3

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 sixteen.
  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.

2015-S717A (ACTIVE) - Details

See Assembly Version of this Bill:: A448
Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Amd §364-j, Soc Serv L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A1720
2011-2012: A1539
2013-2014: S5894, A5346

2015-S717A (ACTIVE) - Summary

2015-S717A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S717A

 TITLE OF BILL :  An act to amend the social services law, in relation
to requiring a managed care program to establish procedures through
which participants will be assured access to medical assistance dental
services to which they are otherwise entitled, other than through the
managed care provider

 PURPOSE OR GENERAL IDEA OF BILL :

This bill allows Medicaid clients who are members of a managed care
program to obtain dental services outside of the medical program.

 SUMMARY OF SPECIFIC PROVISIONS :

Amends subparagraph (iii) of paragraph a of subdivision 4 of section
364-j of the social services law to add dental services to the list of
services which managed care participants may obtain outside of their
medical program.

 JUSTIFICATION :

The Medicaid Managed Care Program was instituted to provide Medicaid
recipients with improved health care through the Services of health
maintenance organizations (HMO's). HMO's improve health care by
establishing a relationship between a patient and a primary care

provider and then maintaining that relationship through all of that
patients' interactions in the health care system.

Dental services have always been provided on a very different track
than other health care services, and HMO's have very little experience
in providing those services. In addition, primary care practitioners
have little training or experience in assessing either the existence
or type of dental problems, or what the appropriate remedy would be.
Consequently, it makes little sense to require them or the HMO to
determine the necessity or degree of treatment needed.  This
legislation preserves both the right of Medicaid HMO's to offer dental
services and the ability for participants to access such Services
outside the network.

 PRIOR LEGISLATIVE HISTORY :

New Bill

 FISCAL IMPLICATIONS :

None expected. Medicaid recipients are currently eligible for dental
services and this legislation does not expand that eligibility.

 EFFECTIVE DATE :
120 days after the date it shall have become law.

2015-S717A (ACTIVE) - Bill Text download pdf

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

                                 717--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health --  recommitted  to
  the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted to said committee

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
  (D) the services PROVIDED are dental services [and are provided  by  a
diagnostic  and  treatment center licensed under article twenty-eight of

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

                                                           LBD02695-02-6

S. 717--A                           2

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
such services was no longer included in the state rate  of  payment  for
medicaid managed care.

S. 717--A                           3

  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.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.