NY State Senate Bill 2009-S7281

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

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 17, 2010	print number 7281a
Jun 17, 2010	amend (t) and recommit to health
Mar 29, 2010	referred to health

Bill Amendments

Original

A (Active)

co-Sponsors

2009-S7281 - Details

See Assembly Version of this Bill:: A11003
Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Add §§365-l & 369-a, amd §367-a, Soc Serv L
Versions Introduced in 2011-2012 Legislative Session:: A3487

2009-S7281 - 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.

2009-S7281 - Sponsor Memo

                                 BILL NUMBER:  S7281

 TITLE OF BILL :
An act to amend the social services law, in relation to limiting the
method of payment for dental services under the medical assistance
program; and providing for the repeal of such provisions upon
expiration thereof


 PURPOSE :
Requires all dental services under the Medicaid program to be
separately administered on a fee-for-service basis subject to maximum
limits set by the New York State Department of Health.

 SUMMARY OF PROVISIONS :
Section 1 adds a new Section 365-1 to the Social Services Law
requiring that Medicaid reimbursement paid to authorized providers for
dental services to patients in capitated programs be the same
reimbursement paid for dental services to patients who are not in
capitated programs.

Section 2 amends Section 367-a of the Social Services Law by adding a
new subdivision 11 to require that all dental services provided
through the Medicaid program be separately paid for at the actual cost
of such services, subject to maximum limits set by the Department of
Health.

Section 3 adds a new Section 369-a to the Social Services Law
requiring an analysis of dental expenditures and utilization patterns
in relation to the Medicaid program, with a report to the Governor and
the Legislature on the findings.

Section 4 contains the effective date, providing that the law take
effect 120 days after it shall have become a law, and that the law
will expire and be repealed effective March 31, 2013.

 JUSTIFICATION :
This legislation clarifies that dental reimbursement shall be carved
out of the Medicaid program for a period of approximately two years
and administered as a separate benefit at the actual cost of dental
services, subject to maximum limitations established by the Department
of Health. Dental reimbursement shall not be capitated and shall
remain in the fee-for-service market for Medicaid. This carve-out of
dental Medicaid services will enhance Medicaid recipients' access to
quality care and will result in a net long-term savings to the
Medicaid system for the cost of dental services. The dental Medicaid
program has enabled many Medicaid recipients to establish a critical
dentist-patient relationship, a relationship which enhances the
quality of health care and prevents more costly procedures, emergency
room utilization, and hospitalization related to dental disease.

The bill, in addition to fostering access to quality care, also will
allow the state to realize substantial savings in the Medicaid dental
program. This is because the bill provides for separate administration
of dental Medicaid benefits on an actual cost basis, subject to
maximum limitations to be set by the Department of Health.  The
Department of Health will be able to control dental Medicaid costs
very directly in this way. As a result, this bill authorizes the
Department of Health to rely on its superior rate-setting
methodologies to cap dental costs in the fee-for-service market.
Similarly, the bill authorizes using utilization review programs to
study and track expenditures, which have been successful in containing
and controlling unnecessary costs. The State's utilization review
programs are more comprehensive and efficient than many private market
utilization review organizations. The State utilization review
program, which can intercept duplicate claims and other inappropriate
claims, generates significant savings. The State could, with relative
ease, ultimately share its utilization data with Medicaid dental
managed care plans to ensure that all Medicaid recipients receive
properly coordinated, quality dental care.

The March 31, 2013 sunset provision, together with the provisions
requiring evaluation of the program and a report of the findings to
the Legislature and Governor by December 31, 2011, will make certain
that the Medicaid payment method for dental services is adequately
monitored. Consequently, the state will remain well positioned to
implement any necessary changes in this payment method to ensure that
New York's Medicaid recipients continue to receive high quality dental
care in a cost effective manner. Finally, the effective date of 120
days gives the State sufficient time to enable Medicaid recipients to
continue to receive necessary dental services without any
administrative disruptions.

 LEGISLATIVE HISTORY :
This is a new Bill.

 FISCAL IMPLICATIONS :
To be determined.

 EFFECTIVE DATE :
The bill takes effect 120 days after it shall have become a law, and
the law will expire and be repealed effective March 31, 2013.

2009-S7281 - Bill Text download pdf

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

                                  7281

                            I N  S E N A T E

                             March 29, 2010
                               ___________

Introduced  by  Sen. SCHNEIDERMAN -- 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  limiting  the
  method  of  payment  for  dental services under the medical assistance
  program; and providing for the repeal of such provisions upon  expira-
  tion thereof

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

  Section 1. The social services law is amended by adding a new  section
365-l to read as follows:
  S  365-L.  PAYMENTS  FOR  DENTAL  SERVICES.  PAYMENTS  FOR  ALL DENTAL
SERVICES AUTHORIZED PURSUANT TO SUBDIVISION TWO OF SECTION THREE HUNDRED
SIXTY-FIVE-A OF THIS TITLE SHALL  NOT  BE  INCLUDED  IN  THE  CAPITATION
PAYMENT  FOR SERVICES OR SUPPLIES PROVIDED TO MEDICAL ASSISTANCE RECIPI-
ENTS BY A HEALTH MAINTENANCE  ORGANIZATION  OR  OTHER  ENTITY  WHICH  IS
CERTIFIED  UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR LICENSED
PURSUANT TO ARTICLE  FORTY-THREE  OF  THE  INSURANCE  LAW  OR  OTHERWISE
AUTHORIZED  BY  LAW  TO  OFFER  COMPREHENSIVE  HEALTH  SERVICES PLANS TO
MEDICAL ASSISTANCE RECIPIENTS.
  S 2. Section 367-a of the social services law is amended by  adding  a
new subdivision 13 to read as follows:
  13. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
THE  CONTRARY,  FOR  ALL DENTAL SERVICES FOR WHICH PAYMENT IS AUTHORIZED
PURSUANT TO SUBDIVISION TWO OF SECTION  THREE  HUNDRED  SIXTY-FIVE-A  OF
THIS  TITLE,  PAYMENTS  UNDER  THIS TITLE SHALL BE MADE AT THE FOLLOWING
AMOUNT: FOR ALL DENTAL SERVICES PROVIDED BY DENTISTS AND  OTHER  AUTHOR-
IZED  DENTAL PRACTITIONERS UNDER TITLE VIII OF THE EDUCATION LAW AND FOR
ALL DENTAL APPLIANCES, THE ACTUAL  COST  OF  SUCH  DENTAL  SERVICES  AND
DENTAL  APPLIANCES  SUBJECT  TO  THE  MAXIMUM  LIMIT  ESTABLISHED BY THE
DEPARTMENT OF HEALTH FOR THOSE DENTAL  SERVICES  AND  DENTAL  APPLIANCES
COVERED UNDER THE MEDICAL ASSISTANCE PROGRAM.
  S  3. The social services law is amended by adding a new section 369-a
to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD16618-01-0

S. 7281                             2

  S 369-A. ANALYSIS OF DENTAL EXPENDITURES AND PATTERNS IN  RELATION  TO
THE  MEDICAL  ASSISTANCE  PROGRAM.  1.  THE  DEPARTMENT  OF HEALTH SHALL
ANALYZE AND COMPARE  EXPENDITURES,  UTILIZATION  RATES  AND  UTILIZATION
PATTERNS  FOR  ALL DENTAL SERVICES AND DENTAL APPLIANCES (ALONG WITH ANY
RELATED  EFFECTS ON EXPENDITURES, RATES AND PATTERNS FOR OTHER SERVICES)
FOR MEDICAL ASSISTANCE RECIPIENTS:
  (A) FOR THE PERIOD DURING WHICH MEDICAL ASSISTANCE  REIMBURSEMENT  FOR
SUCH  DENTAL  SERVICES  AND  DENTAL APPLIANCES WAS PROVIDED PRIOR TO THE
EFFECTIVE DATE OF THIS SECTION; AND
  (B) FOR THE PERIOD BEGINNING WITH THE DATE ON WHICH MEDICAL ASSISTANCE
REIMBURSEMENT  FOR  SUCH  DENTAL  SERVICES  AND  DENTAL  APPLIANCES  WAS
PROVIDED AFTER THE EFFECTIVE DATE OF THIS SECTION.
  2.  THE DEPARTMENT OF HEALTH SHALL INCLUDE IN ITS ANALYSES AND COMPAR-
ISONS, THE EXPENDITURES, UTILIZATION RATES AND UTILIZATION PATTERNS  FOR
ALL  DENTAL  SERVICES  AND  DENTAL  APPLIANCES  (ALONG  WITH ANY RELATED
EFFECTS ON EXPENDITURES, RATES AND PATTERNS FOR OTHER SERVICES) PAID FOR
BY PRIVATE THIRD-PARTY PAYORS.
  3. 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 THIRTY-FIRST, TWO THOUSAND ELEVEN.
  S 4. This act shall take effect on the one hundred twentieth day after
it shall have become a law, and shall  expire  and  be  deemed  repealed
March 31, 2013.

co-Sponsors

2009-S7281A (ACTIVE) - Details

See Assembly Version of this Bill:: A11003
Current Committee:: Senate Health
Law Section:: Social Services Law
Laws Affected:: Add §§365-l & 369-a, amd §367-a, Soc Serv L
Versions Introduced in 2011-2012 Legislative Session:: A3487

2009-S7281A (ACTIVE) - Summary

2009-S7281A (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S7281A

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, as
amended by chapter 649 of the laws of 1996 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 re~ire 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:
2002:    A.9300 - Reported to Ways and Means Committee
2003:    A.5770 - Reported to Ways and Means
2004:    A.5770 - Referred to Health Committee
2005-06: A.5282 - Passed the Assembly
2007-08: A.3819-A - Passed the Assembly

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.

2009-S7281A (ACTIVE) - Bill Text download pdf

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

                                 7281--A

                            I N  S E N A T E

                             March 29, 2010
                               ___________

Introduced  by  Sens.  SCHNEIDERMAN,  STEWART-COUSINS  -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Health  --  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, 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
to this clause shall prior to June first of  each  year  report  to  the

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

                                                           LBD16618-02-0

S. 7281--A                          2

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 eleven.
  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.

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Senate Bill S7281

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

co-Sponsors

2009-S7281 - Details

2009-S7281 - Summary

2009-S7281 - Sponsor Memo

2009-S7281 - Bill Text download pdf

co-Sponsors

2009-S7281A (ACTIVE) - Details

2009-S7281A (ACTIVE) - Summary

2009-S7281A (ACTIVE) - Sponsor Memo

2009-S7281A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S7281

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Sponsored By

Eric T. Schneiderman

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

co-Sponsors

Andrea Stewart-Cousins

2009-S7281 - Details

2009-S7281 - Summary

2009-S7281 - Sponsor Memo

2009-S7281 - Bill Text download pdf

co-Sponsors

Andrea Stewart-Cousins

2009-S7281A (ACTIVE) - Details

2009-S7281A (ACTIVE) - Summary

2009-S7281A (ACTIVE) - Sponsor Memo

2009-S7281A (ACTIVE) - Bill Text download pdf

Comments