Bill S5894-2013

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

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.

Details

Actions

  • Jan 8, 2014: REFERRED TO HEALTH
  • Jun 19, 2013: REFERRED TO RULES

Memo

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.


Text

STATE OF NEW YORK ________________________________________________________________________ 5894 2013-2014 Regular Sessions IN SENATE 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
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.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Discuss!

blog comments powered by Disqus