S T A T E   O F   N E W   Y O R K
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                                  1539

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                            January 10, 2011
                               ___________

Introduced by M. of A. GOTTFRIED, GLICK, CLARK, JACOBS, V. LOPEZ, ORTIZ,
  PAULIN,  BROOK-KRASNY  --  Multi-Sponsored  by  --  M.  of A. BRENNAN,
  COLTON, COOK, CYMBROWITZ, GANTT, HOOPER, JAFFEE,  LIFTON,  MAGNARELLI,
  MAYERSOHN,  McENENY,  MILLMAN,  PHEFFER,  WEISENBERG  -- read once and
  referred to the Committee on Social Services

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

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05345-01-1

A. 1539                             2

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
  (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 twelve.
  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.