senate Bill S5894

2013-2014 Legislative Session

Requires managed care programs to establish procedures to assure participant access to dental services to which entitled, other than through managed care provider

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Archive: Last Bill Status - In Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to health
Jun 19, 2013 referred to rules

S5894 - Bill Details

See Assembly Version of this Bill:
A5346
Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd ยง364-j, Soc Serv L
Versions Introduced in Previous Legislative Sessions:
2011-2012: A1539
2009-2010: A1720B

S5894 - Bill Texts

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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.

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BILL NUMBER:S5894

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 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 ox experience in assessing either the existence
or type of dental problems, or what the appropriate remedy would be.
Consequently, it makes little sense to require 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:

New Bill

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.

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

                                  5894

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 19, 2013
                               ___________

Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules

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.
                                                           LBD01214-01-3

S. 5894                             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 fourteen.
  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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