S T A T E O F N E W Y O R K
________________________________________________________________________
1834
2011-2012 Regular Sessions
I N A S S E M B L Y
January 12, 2011
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Introduced by M. of A. WRIGHT, JAFFEE -- Multi-Sponsored by -- M. of A.
BOYLAND, BRENNAN, GLICK, HEASTIE, TOWNS, WEISENBERG -- 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 allocating monies for dental health services in the medi-
caid managed care program, the child health insurance program, and the
family health plus program
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 2511 of the public health law is amended by adding
a new subdivision 21 to read as follows:
21. EVERY APPROVED ORGANIZATION THAT PROVIDES COVERAGE FOR ANY DENTAL
SERVICE SHALL SPEND NOT LESS THAN EIGHTY PERCENT OF THE CAPITATION OR
OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR DENTAL SERVICES,
WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
FOR THE PROVISION OF DENTAL SERVICES TO PATIENTS BY LICENSED DENTISTS.
IN THE EVENT THE APPROVED ORGANIZATION SPENDS LESS THAN EIGHTY PERCENT
OF THE CAPITATION OR OTHER STATE FUNDS PAID TO IT FOR DENTAL SERVICES,
WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
FOR THE PROVISION OF DENTAL SERVICES, THE DIFFERENCE SHALL BE RETURNED
TO THE DEPARTMENT. IN NO EVENT SHALL MORE THAN TWENTY PERCENT OF THE
CAPITATION OR OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR
DENTAL SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER
DIRECTLY OR INDIRECTLY, BE SPENT BY ANY APPROVED ORGANIZATION ON ADMIN-
ISTRATIVE SERVICES IN LIEU OF DENTAL SERVICES FOR PATIENTS. THE DEPART-
MENT SHALL PROVIDE AN APPROVED ORGANIZATION WITH A CERTIFICATION LETTER
INDICATING THE AMOUNT OF CAPITATION OR OTHER STATE FUNDS PAID FOR DENTAL
SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR
INDIRECTLY, DURING EACH YEAR PURSUANT TO THIS SECTION.
S 2. Section 364-j of the social services law is amended by adding a
new subdivision 25 to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06262-01-1
A. 1834 2
25. EVERY MANAGED CARE PROVIDER AND MANAGED CARE PROGRAM THAT PROVIDES
COVERAGE FOR ANY DENTAL SERVICE SHALL SPEND NOT LESS THAN EIGHTY PERCENT
OF THE CAPITATION OR OTHER STATE FUNDS PAID TO THE MANAGED CARE PROVIDER
OR MANAGED CARE PROGRAM FOR DENTAL SERVICES, WHETHER AS A PREMIUM OR IN
ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY, FOR THE PROVISION OF
DENTAL SERVICES TO PATIENTS BY LICENSED DENTISTS. IN THE EVENT THE
MANAGED CARE PROVIDER OR MANAGED CARE PROGRAM SPENDS LESS THAN EIGHTY
PERCENT OF THE CAPITATION OR OTHER STATE FUNDS PAID TO IT FOR DENTAL
SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR
INDIRECTLY, FOR THE PROVISION OF DENTAL SERVICES, THE DIFFERENCE SHALL
BE RETURNED TO THE DEPARTMENT. IN NO EVENT SHALL MORE THAN TWENTY
PERCENT OF THE CAPITATION OR OTHER STATE FUNDS PAID TO THE MANAGED CARE
PROVIDER OR MANAGED CARE PROGRAM FOR DENTAL SERVICES, WHETHER AS A
PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY, BE SPENT BY
ANY MANAGED CARE PROVIDER OR MANAGED CARE PROGRAM ON ADMINISTRATIVE
SERVICES IN LIEU OF DENTAL SERVICES FOR PATIENTS. THE DEPARTMENT SHALL
PROVIDE A MANAGED CARE PROVIDER AND MANAGED CARE PROGRAM WITH A CERTIF-
ICATION LETTER INDICATING THE AMOUNT OF CAPITATION OR OTHER STATE FUNDS
PAID FOR DENTAL SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM
EITHER DIRECTLY OR INDIRECTLY, DURING EACH YEAR PURSUANT TO THIS
SECTION.
S 3. Section 369-ee of the social services law is amended by adding a
new subdivision 8 to read as follows:
8. EVERY APPROVED ORGANIZATION THAT PROVIDES COVERAGE FOR ANY DENTAL
SERVICE SHALL SPEND NOT LESS THAN EIGHTY PERCENT OF THE CAPITATION OR
OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR DENTAL SERVICES,
WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
FOR THE PROVISION OF DENTAL SERVICES TO PATIENTS BY LICENSED DENTISTS.
IN THE EVENT THE APPROVED ORGANIZATION SPENDS LESS THAN EIGHTY PERCENT
OF THE CAPITATION OR OTHER STATE FUNDS PAID TO IT FOR DENTAL SERVICES,
WHETHER AS A PREMIUM OR IN ANY OTHER FORM DIRECTLY OR INDIRECTLY, FOR
THE PROVISION OF DENTAL SERVICES, THE DIFFERENCE SHALL BE RETURNED TO
THE DEPARTMENT. IN NO EVENT SHALL MORE THAN TWENTY PERCENT OF THE CAPI-
TATION OR OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR DENTAL
SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR
INDIRECTLY, BE SPENT BY ANY APPROVED ORGANIZATION ON ADMINISTRATIVE
SERVICES IN LIEU OF DENTAL SERVICES FOR PATIENTS. THE DEPARTMENT SHALL
PROVIDE AN APPROVED ORGANIZATION WITH A CERTIFICATION LETTER INDICATING
THE AMOUNT OF CAPITATION OR OTHER STATE FUNDS PAID FOR DENTAL SERVICES,
WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
DURING EACH YEAR PURSUANT TO THIS SECTION.
S 4. This act shall take effect January 1, 2012, provided, however,
that the amendments to section 364-j of the social services law made by
section two of this act shall not affect the repeal of such section and
shall be deemed repealed therewith.