The New York State Senate

S1212A (ACTIVE) - Bill Texts

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Modifies availability of medicaid services to bring them more in line with those of private health insurance coverage.

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BILL NUMBER:S1212A

TITLE OF BILL: An act to amend the social services law, in relation to
the character and adequacy of Medicaid assistance and to repeal para-
graph (n) of subdivision 2 of section 365-a of the social services law
relating to the care and services of audiologists

PURPOSE OF THE BILL:

Modifies the availability of Medicaid services to bring them more in
line with those of private health insurance coverage.

SUMMARY OF SPECIFIC PROVISIONS:

§ 1- Amends paragraph (a) of subdivision 2 of § 365-a of the Social
Services Law to remove dentists, nurses, and private duty nursing from
those services authorized under the subdivision. However, nurse midwives
and nurse practitioners are added.

§ 2- Amends paragraph (f) of subdivision 2 of § 365-a of the Social
Services Law to specify that coverage for preventive, prophylactic and
other routine dental care, services and supplies will be authorized only
when provided in a hospital outpatient or clinic facility.

§ 3- Amends paragraph (g) of subdivision 2 of § 365-a of the Social
Services Law to remove dental prosthetic appliances from those services
authorized under the subdivision and to authorize the Commissioner of
Health to require prior approval of any prescription drug that is
prescribed for a resident of a nursing home that is not reimbursed as
part of the nursing home's Medicaid rate.

§ 4- Amends paragraph (l) of subdivision 2 of § 365-a of the Social
Services Law to add clinical psychologists, nurses and audiologists,
including such care and services provided in a hospital outpatient or
clinic facility, and dentists in those services and care provided in
accordance with the program of early and periodic screening and diagno-
sis.

§ 5- Repeals paragraph (n) of subdivision 2 of § 365-a of the Social
Services Law which relates to services provided by audiologists.

§ 6- Allows the Commissioner of Health to promulgate or adopt any rules
or regulations necessary to implement the provisions of the bill.

§ 7- Effective date.

JUSTIFICATION:

The ultimate goal of this legislation is to bring Medicaid coverage more
in line with private health insurance coverage. The costs associated
with "optional" services, those allowed for but not required by the
federal government but required by New York State, have increased

substantially, causing fiscal strife for many of the state's counties.
These costs are often passed along to the citizens of the state through
higher property taxes or other tax increases. This legislation in no way
suggests that monetary concerns outweigh the care of individuals. Howev-
er, it is unfair and inappropriate to ask working families to pay for
services covered under "optional" Medicaid coverage that they themselves
may not be able to afford or obtain under their own private health
insurance plan.

PRIOR LEGISLATIVE HISTORY:

2005-2006: A.5465-A
2007-2008: A.4674
2009-2010: S.7950/A.6677 -- HEALTH/Health
2011: S.2684 - HEALTH;
2012: S.2684/A.2340-A HEALTH/Health
2013: S.1212/A.2714 - HEALTH/Health

FISCAL IMPLICATIONS:

Yet to be determined. Cost savings to both counties and the state are
expected.

EFFECTIVE DATE:

On the one hundred eightieth day after it shall have become a law.

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

                                 1212--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens. RANZENHOFER, BONACIC, DeFRANCISCO, LARKIN, MAZIARZ
  -- read twice and ordered printed, and when printed to be committed to
  the Committee on Health -- recommitted to the Committee on  Health  in
  accordance  with  Senate  Rule 6, sec. 8 -- committee discharged, bill
  amended, ordered reprinted as amended and recommitted to said  commit-
  tee

AN  ACT  to  amend the social services law, in relation to the character
  and adequacy of Medicaid assistance and to  repeal  paragraph  (n)  of
  subdivision  2 of section 365-a of the social services law relating to
  the care and services of audiologists

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

  Section  1.  Paragraph  (a)  of  subdivision 2 of section 365-a of the
social services law, as amended by chapter 47 of the laws  of  1996,  is
amended to read as follows:
  (a)  services  of qualified physicians, [dentists, nurses, and private
duty nursing services shall be further  subject  to  the  provisions  of
section  three  hundred  sixty-seven-o  of  this chapter,] optometrists,
NURSE MIDWIVES, NURSE  PRACTITIONERS,  and  other  related  professional
personnel;
  S  2.  Paragraph  (f)  of subdivision 2 of section 365-a of the social
services law, as added by chapter 184 of the laws of 1969 and as  relet-
tered by chapter 478 of the laws of 1980, is amended to read as follows:
  (f)  preventive,  prophylactic and other routine dental care, services
and supplies ONLY WHEN PROVIDED  IN  A  HOSPITAL  OUTPATIENT  OR  CLINIC
FACILITY REFERRED TO IN PARAGRAPH (C) OF THIS SUBDIVISION;
  S  3.  Paragraph  (g)  of subdivision 2 of section 365-a of the social
services law, as amended by section 21 of part A of chapter  56  of  the
laws of 2013, is amended to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04839-02-4

S. 1212--A                          2

  (g)  sickroom  supplies,  eyeglasses,  AND  prosthetic appliances [and
dental prosthetic appliances] furnished in  accordance  with  the  regu-
lations  of  the department; provided further that: (i) the commissioner
of health is authorized to implement a preferred diabetic supply program
wherein  the  department  of  health  will receive enhanced rebates from
preferred manufacturers of glucometers and test strips, and may  subject
non-preferred  manufacturers'  glucometers  and  test  strips  to  prior
authorization under section two  hundred  seventy-three  of  the  public
health law; (ii) enteral formula therapy and nutritional supplements are
limited  to  coverage  only for nasogastric, jejunostomy, or gastrostomy
tube feeding, for treatment of  an  inborn  metabolic  disorder,  or  to
address  growth  and  development  problems  in children, or, subject to
standards established by the commissioner, for persons with a  diagnosis
of  HIV  infection,  AIDS  or  HIV-related illness or other diseases and
conditions; (iii) prescription  footwear  and  inserts  are  limited  to
coverage  only  when  used  as an integral part of a lower limb orthotic
appliance, as part of a diabetic treatment plan, or  to  address  growth
and  development  problems  in  children;  (iv)  compression and support
stockings are limited to coverage only for  pregnancy  or  treatment  of
venous  stasis  ulcers; and (v) the commissioner of health is authorized
to implement an incontinence supply utilization  management  program  to
reduce  costs  without  limiting  access  through  the existing provider
network,  including  but  not  limited  to  single  or  multiple  source
contracts  or,  a  preferred  incontinence  supply  program  wherein the
department of  health  will  receive  enhanced  rebates  from  preferred
manufacturers  of  incontinence  supplies, and may subject non-preferred
manufacturers' incontinence supplies to prior approval pursuant to regu-
lations of the department, provided any necessary approvals under feder-
al law have been obtained to receive federal financial participation  in
the  costs  of  incontinence supplies provided pursuant to this subpara-
graph; AND (VI) THE COMMISSIONER OF  HEALTH  IS  AUTHORIZED  TO  REQUIRE
PRIOR  APPROVAL  OF ANY PRESCRIPTION DRUG THAT IS PRESCRIBED FOR A RESI-
DENT OF A NURSING HOME AND THAT IS NOT REIMBURSED AS PART OF THE NURSING
HOME'S MEDICAID RATE;
  S 4. Paragraph (l) of subdivision 2 of section  365-a  of  the  social
services  law,  as amended by chapter 81 of the laws of 1995, is amended
to read as follows:
  (l) care and services of podiatrists, CLINICAL  PSYCHOLOGISTS,  NURSES
AND  AUDIOLOGISTS, INCLUDING SUCH CARE AND SERVICES PROVIDED IN A HOSPI-
TAL OUT-PATIENT OR CLINIC FACILITY REFERRED TO IN PARAGRAPH (C) OF  THIS
SUBDIVISION,  AND  DENTISTS,  which  care  and  services  shall  only be
provided upon referral by a physician, nurse practitioner  or  certified
nurse  midwife  in  accordance  with  the  program of early and periodic
screening and diagnosis established pursuant  to  subdivision  three  of
this  section  or  to persons eligible for benefits under title XVIII of
the federal social security act as qualified medicare  beneficiaries  in
accordance  with  federal requirements therefor [and private duty nurses
which care and services shall only be provided in accordance with  regu-
lations  of  the  department  of health; provided, however, that private
duty nursing services shall not be restricted  when  such  services  are
more  appropriate and cost-effective than nursing services provided by a
home health agency pursuant to section three hundred sixty-seven-l];
  S 5. Paragraph (n) of subdivision 2 of section  365-a  of  the  social
services law, as added by chapter 556 of the laws of 1986, is REPEALED.
  S  6.  The commissioner of health is authorized to promulgate or adopt
any rules or regulations necessary to implement the provisions  of  this

S. 1212--A                          3

act and any procedures, forms, or instructions necessary for such imple-
mentation  may  be  adopted and issued on or after the effective date of
this act. Notwithstanding any inconsistent provision of the state admin-
istrative  procedure  act  or  any other provision of law, rule or regu-
lation, the commissioner of health and the superintendent  of  insurance
and  any  appropriate council is authorized to adopt or amend or promul-
gate on an emergency basis any regulation he  or  she  or  such  council
determines  necessary  to  implement  any  provision  of this act on its
effective date.
  S 7. This act shall take effect on the one hundred eightieth day after
it shall have become a law.