S T A T E O F N E W Y O R K
________________________________________________________________________
448--A
2015-2016 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 7, 2015
___________
Introduced by M. of A. GOTTFRIED, GLICK, ORTIZ, PAULIN -- Multi-Spon-
sored by -- M. of A. BRENNAN, COLTON, COOK, CYMBROWITZ, GANTT, HOOPER,
JAFFEE, LIFTON, MAGNARELLI, PERRY -- read once and referred to the
Committee on Health -- recommitted to the Committee on Health in
accordance with Assembly Rule 3, sec. 2 -- 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 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, clause (E-1) as
added by chapter 449 of the laws of 2013, 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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02695-03-6
A. 448--A 2
(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
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
(E-1) the services are vision care services rendered to a student at a
school based health center approved by the commissioner pursuant to this
clause. The commissioner may approve up to five pilot programs at school
based health centers in partnership with a charitable foundation that
agrees to provide free of charge eyeglass frames and lenses at the
centers pursuant to a memorandum of agreement approved by the commis-
sioner. The commissioner may approve the rate for such vision care
services at the rate for such services when provided by a federally
qualified health center or when provided by another entity licensed
pursuant to article twenty-eight of the public health law and eligible
for the ambulatory patient group rate approved for vision care services
by the commissioner; 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
A. 448--A 3
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 seventeen.
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.