NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8360
SPONSOR: Woerner TITLE OF BILL:
An act to amend the insurance law, in relation to standardized health
insurance contracts for small dental employers; and providing for the
repeal of such provisions upon the expiration thereof
PURPOSE OR GENERAL IDEA OF BILL:
The purpose of this bill is to boost the pool of dentists providing
services to Medicaid patients by qualifying certain dental practices as
eligible to participate in the Healthy New York health insurance
program.
SUMMARY OF PROVISIONS:
Section 1: Amends section 4326 of the insurance law to expand its appli-
cability to qualifying small dental employers, defined as a dental prac-
tice with fifty or fewer employees that employs at least two dental
hygienists and where each and every dentist in the practice provides at
least ten dental office visits per month to patients receiving medical
assistance coverage. § 2 amends sections 4327 of the insurance law to
expand the coverage of stop loss funds for standardized health insurance
contracts to include coverage for qualifying small dental employers. § 3
establishes the effective date.
JUSTIFICATION:
Despite graduating 750 dentists annually - among the highest numbers of
any state - New York continues to struggle with unmet need, particularly
with respect to Medicaid recipients and other vulnerable populations.
Several barriers contribute to the challenges of providing access to
dental care to low-income, rural or developmentally disabled individ-
uals, including the exorbitant costs of attending dental school,1 the
high costs of establishing a dental practice, and perennially insuffi-
cient Medicaid reimbursement rates. This bill seeks to lower overall
dental practice expenses by offering qualified dental practices the
ability to purchase health insurance coverage for their employees and,
if desired, the families of their employees, through the Healthy New
York insurance program.
New York State currently has 156 dental Health Practitioner Shortage
Areas (HPSAs), including 92 designated HPSA facilities and 64 designated
HPSA population groups (mostly Medicaid eligible populations).2 This
means that each of. these designations has a population-to-provider
ratio of at least 4000 people to 1 dentist. NYS currently meets only
16.68% of the documented need, so it is imperative that we find ways to
attract dentists and other oral health professionals to practice in
these HPSAs, including by making it financially viable to do so. Recog-
nizing that most dentists practice in private practice settings,3 this
bill seeks to make it easier for dentists to practice in a HPSA by
lowering a major driver of dental practice costs.
PRIOR LEGISLATIVE HISTORY: New bill.
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None
EFFECTIVE DATE:
This act shall take effect immediately.
1 Whereas the average medical school graduate in 2023 owes $251,000, the
average dental student in 2023 owes $293,900. See
https://educationdata.org/average-medical-school-debt and
www.lendingtree.com/student/dental-school-worth-it
2 Health Resources and Services Administration, U.S. Department of
Health & Human Services. Health Workforce Shortage Areas.
https://data.hrsa.gov/topics/health-workforce/shortage-areas Accessed
online on 11/27/2023.
3 Wendling, Ph.D., Wayne R., Edelstein, Burton L., D.D.S., M.P.H., Weav-
er, M.D., Donald L, Brand, Ph.D., Marcia, The U.S. Oral Health Workforce
in the Coming Decade: Workshop Summary. Institute of Medicine (U.S.)
Board of Health Care Services, Washington, D.C., 2009. See
https://www.ncbi.nlm.nih.gov/books/NBK219677/
STATE OF NEW YORK
________________________________________________________________________
8360
2023-2024 Regular Sessions
IN ASSEMBLY
December 13, 2023
___________
Introduced by M. of A. WOERNER, McDONALD, ANGELINO, MAGNARELLI, DeSTEFA-
NO, LUPARDO, SIMON, PAULIN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to standardized health
insurance contracts for small dental employers; and providing for the
repeal of such provisions upon the expiration thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The section heading and subsections (a), (c), (g), (h), (i)
2 and (k) of section 4326 of the insurance law, as amended by section 56
3 of part D of chapter 56 of the laws of 2013, are amended to read as
4 follows:
5 Standardized health insurance contracts for qualifying small
6 employers, qualifying small dental employers and individuals. (a) A
7 program is hereby established for the purpose of making standardized
8 health insurance contracts available to qualifying small employers and
9 qualifying small dental employers as defined in this section. Such
10 program is designed to encourage small employers to offer health insur-
11 ance coverage to their employees.
12 (c) The following definitions shall be applicable to the insurance
13 contracts offered under the program established by this section:
14 (1) (A) A qualifying small employer is an employer with:
15 (i) not more than fifty employees;
16 (ii) no group health insurance that provides benefits on an expense
17 reimbursed or prepaid basis covering employees in effect during the
18 twelve month period prior to application for a qualifying group health
19 insurance contract under the program established by this section; and
20 (iii) at least thirty percent of its employees receiving annual wages
21 from the employer at a level equal to or less than thirty thousand
22 dollars. The thirty thousand dollar figure shall be adjusted period-
23 ically pursuant to subparagraph (D) of this paragraph.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13499-01-3
A. 8360 2
1 (B) The twelve month period set forth in item (ii) of subparagraph (A)
2 of this paragraph may be adjusted by the superintendent from twelve
3 months to eighteen months if he determines that the twelve month period
4 is insufficient to prevent inappropriate substitution of qualifying
5 group health insurance contracts for other health insurance contracts.
6 (C) An employer shall cease to be a qualifying small employer if any
7 health insurance that provides benefits on an expense reimbursed or
8 prepaid basis covering an employer's employees, other than qualifying
9 group health insurance purchased pursuant to this section, is purchased
10 or otherwise takes effect subsequent to purchase of qualifying group
11 health insurance under the program established by this section.
12 (D) The wage levels utilized in subparagraph (A) of this paragraph
13 shall be adjusted annually, beginning in two thousand two. The adjust-
14 ment shall take effect on July first of each year. For July first, two
15 thousand two, the adjustment shall be a percentage of the annual wage
16 figure specified in subparagraph (A) of this paragraph. For subsequent
17 years, the adjustment shall be a percentage of the annual wage figure
18 that took effect on July first of the prior year. The percentage adjust-
19 ment shall be the same percentage by which the current year's non-farm
20 federal poverty level, as defined and updated by the federal department
21 of health and human services, for a family unit of four persons for the
22 forty-eight contiguous states and Washington, D.C., changed from the
23 same level established for the prior year.
24 (2) (A) A qualifying small dental employer is an employer with:
25 (i) not more than fifty employees;
26 (ii) at least one dentist licensed as a dentist under section sixty-
27 six hundred four of the education law who practices general dentistry,
28 provided that such dentist, and any additional dentist similarly
29 licensed and practicing general dentistry with whom such dentist prac-
30 tices in the same location, shall each provide at least ten dental
31 office visits per month to patients receiving medical assistance cover-
32 age under title eleven of article five of the social services law.
33 Dental office visits provided to such patients shall include all
34 services routinely provided to patients at such office location,
35 provided that the services are covered by the patient's medical assist-
36 ance coverage; and
37 (iii) at least two dental hygienists licensed as dental hygienists
38 under section sixty-six hundred nine of the education law.
39 (B) An employer shall cease to be a qualifying small dental employer
40 if any health insurance that provides benefits on an expense reimbursed
41 or prepaid basis covering an employer's employees, other than qualifying
42 group health insurance purchased pursuant to this section, is purchased
43 or otherwise takes effect subsequent to purchase of qualifying group
44 health insurance under the program established by this section.
45 (3) A qualifying group health insurance contract is a group contract
46 purchased from a health maintenance organization, corporation or insurer
47 by a qualifying small employer or qualifying small dental employer that
48 provides the benefits set forth in subsection (d) of this section. The
49 contract must insure not less than fifty percent of the employees.
50 (g) A health maintenance organization, corporation or insurer must
51 offer the benefit package without change or additional benefits. A qual-
52 ifying small employer or qualifying small dental employer shall be
53 issued the benefit package in a qualifying group health insurance
54 contract.
55 (h) A health maintenance organization, corporation or insurer shall
56 obtain from the employer written certification at the time of initial
A. 8360 3
1 application and annually thereafter ninety days prior to the contract
2 renewal date that such employer meets the requirements of a qualifying
3 small employer or qualifying small dental employer pursuant to this
4 section. A health maintenance organization, corporation or insurer may
5 require the submission of appropriate documentation in support of the
6 certification.
7 (i) Applications for qualifying group health insurance contracts must
8 be accepted from any qualifying small employer or qualifying small
9 dental employer at all times throughout the year. The superintendent, by
10 regulation, may require health maintenance organizations, corporations
11 or insurers to give preference to qualifying small employers whose
12 employees have the lowest average salaries and to qualifying small
13 dental employers who serve more than the threshold number of patients
14 receiving medical assistance coverage under title eleven of article five
15 of the social services law as identified in item (ii) of subparagraph
16 (A) of paragraph two of subsection (c) of this section.
17 (k) A qualifying small employer or qualifying small dental employer
18 shall elect whether to make coverage under the qualifying group health
19 insurance contract available to dependents of employees. Any employee or
20 dependent who is enrolled in Medicare is ineligible for coverage, unless
21 required by federal law. Dependents of an employee who is enrolled in
22 Medicare will be eligible for dependent coverage provided the dependent
23 is not also enrolled in Medicare.
24 § 2. The section heading and subsections (m), (m-1) and (n) of section
25 4327 of the insurance law, the section heading and subsections (m) and
26 (n) as amended by section 58 of part D of chapter 56 of the laws of
27 2013, and subsection (m-1) as amended by section 38 of subpart B of part
28 J of chapter 57 of the laws of 2019, are amended to read as follows:
29 Stop loss funds for standardized health insurance contracts issued to
30 qualifying small employers, qualifying small dental employers and quali-
31 fying individuals.
32 (m) If at any point during a suspension of enrollment of new qualify-
33 ing small employers and qualifying small dental employers, the super-
34 intendent determines that funds are sufficient to provide for the addi-
35 tion of new enrollments, the superintendent shall be authorized to
36 reactivate new enrollments and to notify all health maintenance organ-
37 izations, corporations or insurers that enrollment of new employers may
38 again commence.
39 (m-1) In the event that the superintendent suspends the enrollment of
40 new individuals for qualifying group health insurance contracts, the
41 superintendent shall ensure that small employers, including small dental
42 employers, seeking to enroll in a qualified group health insurance
43 contract pursuant to section forty-three hundred twenty-six of this
44 article are provided information on and directed to coverage options
45 available through the health benefit exchange established by this state.
46 (n) The suspension of issuance of qualifying group health insurance
47 contracts to new qualifying small employers and qualifying small dental
48 employers shall not preclude the addition of new employees of an employ-
49 er already covered under such a contract or new dependents of employees
50 already covered under such contracts.
51 § 3. This act shall take effect one year after it shall have become a
52 law and shall expire and be deemed repealed 5 years after such date.
53 Effective immediately, the addition, amendment and/or repeal of any rule
54 or regulation necessary for the implementation of this act on its effec-
55 tive date are authorized to be made and completed on or before such
56 effective date.
