Modifies availability of medicaid services to bring them more in line with those of private health insurance coverage.
TITLE OF BILL: 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
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 (t) 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 (1) 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 diagnosis.
§ 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. However, 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: 2007-2008: A.4674 2005-2006: A.5465-A 2009-2010: S.7950/A.6677 -- HEALTH/Health 2011: S.2684 - HEALTH; 2012: S.2684/A.2340-A - 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.
STATE OF NEW YORK ________________________________________________________________________ 1212 2013-2014 Regular Sessions IN SENATE (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 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 7 of part D of chapter 56 of the laws of 2012, is amended to read as follows: (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 programEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04839-01-3 S. 1212 2
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;
[and](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 REQUIRE PRIOR APPROVAL OF ANY PRESCRIPTION DRUG THAT IS PRESCRIBED FOR A RESIDENT 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 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.