S T A T E O F N E W Y O R K
________________________________________________________________________
3487
2011-2012 Regular Sessions
I N A S S E M B L Y
January 25, 2011
___________
Introduced by M. of A. WRIGHT -- read once and referred to the Committee
on Social Services
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.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06946-01-1
A. 3487 2
S 3. The social services law is amended by adding a new section 369-a
to read as follows:
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 TWELVE.
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, 2014.