S T A T E O F N E W Y O R K
________________________________________________________________________
727
2009-2010 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 7, 2009
___________
Introduced by M. of A. GOTTFRIED, JACOBS -- Multi-Sponsored by -- M. of
A. HOOPER, JOHN, McENENY -- read once and referred to the Committee on
Health
AN ACT to amend the public health law and the social services law, in
relation to creating dental health maintenance organizations and
including them in medicaid managed care
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subdivision 1 of section 4401 of the public health law, as
added by chapter 938 of the laws of 1976, is amended to read as follows:
1. "Health maintenance organization" or "organization" means any
person, natural or corporate, or any groups of such persons who enter
into an arrangement, agreement or plan or any combination of arrange-
ments or plans which propose to provide or offer, or which do provide or
offer, a comprehensive health services plan, OR ANY OTHER ENTITY CERTI-
FIED UNDER THIS ARTICLE.
S 2. Section 4401 of the public health law is amended by adding a new
subdivision 8 to read as follows:
8. "DENTAL HEALTH MAINTENANCE ORGANIZATION" MEANS ANY HEALTH MAINTE-
NANCE ORGANIZATION CERTIFIED UNDER SECTION FORTY-FOUR HUNDRED THREE-G OF
THIS ARTICLE.
S 3. The public health law is amended by adding a new section 4403-g
to read as follows:
S 4403-G. DENTAL HEALTH MAINTENANCE ORGANIZATIONS. A HEALTH MAINTE-
NANCE ORGANIZATION MAY BE CERTIFIED UNDER SECTION FORTY-FOUR HUNDRED
EIGHT-A OF THIS ARTICLE, AS ADDED BY CHAPTER SIX HUNDRED THIRTY-NINE OF
THE LAWS OF NINETEEN HUNDRED NINETY-SIX, TO BE A DENTAL HEALTH MAINTE-
NANCE ORGANIZATION, WHICH SHALL BE SUBJECT TO ALL PROVISIONS OF THIS
ARTICLE AND TO ANY OTHER LAW APPLICABLE TO A HEALTH MAINTENANCE ORGAN-
IZATION, EXCEPT THAT THE HEALTH SERVICES PLAN OF A DENTAL HEALTH MAINTE-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02580-01-9
A. 727 2
NANCE ORGANIZATION SHALL BE LIMITED TO COMPREHENSIVE DENTAL HEALTH
SERVICES, INCLUDING DENTISTRY AND HEALTH CARE SERVICES DIRECTLY RELATED
TO DENTISTRY. REGULATIONS UNDER THIS ARTICLE SHALL INCLUDE SPECIAL
PROVISIONS FOR DENTAL HEALTH MAINTENANCE ORGANIZATIONS, AS APPROPRIATE.
S 4. Subparagraphs (ii) and (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, are amended and a new subpara-
graph (iv) is added to read as follows:
(ii) provided, however, if a major public hospital, as defined in the
public health law, is designated by the commissioner of health as a
managed care provider in a social services district the commissioner of
health shall designate at least one other managed care provider which is
not a major public hospital or facility operated by a major public
hospital; [and]
(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 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 gover-
nor, 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) other services as defined by the commissioner of health[.]; AND
(IV) A MANAGED CARE PROGRAM MAY CONTRACT DIRECTLY WITH A DENTAL HEALTH
MAINTENANCE ORGANIZATION (CERTIFIED UNDER SECTION FORTY-FOUR HUNDRED
THREE-G OF THE PUBLIC HEALTH LAW) FOR THE PURPOSES OF PROVIDING COMPRE-
HENSIVE DENTAL HEALTH SERVICES.
S 5. This act shall take effect immediately, provided, however, that
the amendments to subdivision 4 of section 364-j of the social services
law made by section four of this act shall not affect the repeal of such
section and shall be deemed repealed therewith.