New York State Assembly

 
•  Summary 
 
•  Actions 
 
•  Floor Votes 
 
•  Memo 
 
•  Text 

A01720 Summary:

A01720 Actions:

A01720 Floor Votes:

A01720 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         1720--B
                                                                Cal. No. 150
 
                               2009-2010 Regular Sessions
 
                   IN ASSEMBLY
 
                                     January 9, 2009
                                       ___________
 
        Introduced by M. of A. GOTTFRIED, GLICK, CLARK, JACOBS, V. LOPEZ, ORTIZ,
          PAULIN,  BROOK-KRASNY  --  Multi-Sponsored  by  --  M.  of A. BRENNAN,
          COLTON, COOK, CYMBROWITZ,  ESPAILLAT,  GANTT,  HOOPER,  JAFFEE,  JOHN,
          LIFTON,  MAGNARELLI,  MAYERSOHN, McENENY, MILLMAN, PHEFFER, WEISENBERG

          -- read once and referred to  the  Committee  on  Social  Services  --
          reported  from  committee,  advanced  to  a third reading, amended and
          ordered reprinted, retaining its place on the order of  third  reading
          --  reported  from committee, advanced to a third reading, amended and
          ordered reprinted, retaining its place on the order of third reading
 
        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:
 
     1    Section  1.  Subparagraph  (iii)  of paragraph (a) of subdivision 4 of

     2  section 364-j of the social services law, as amended by  section  14  of
     3  part C of chapter 58 of the laws of 2004, clause (E) as added and clause
     4  (F)  as relettered by chapter 37 of the laws of 2010, is amended to read
     5  as follows:
     6    (iii) under a managed care program, not  all  managed  care  providers
     7  must be required to provide the same set of medical assistance services.
     8  The  managed  care  program  shall  establish  procedures  through which
     9  participants will be assured access to all medical  assistance  services
    10  to  which  they  are  otherwise entitled, other than through the managed
    11  care provider, where:
    12    (A) the service is not reasonably  available  directly  or  indirectly
    13  from the managed care provider,
    14    (B) it is necessary because of emergency or geographic unavailability,
    15  or
 

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00779-03-0
        A. 1720--B                          2
 
     1    (C) the services provided are family planning services; or
     2    (D)  the  services provided are dental services [and are provided by a
     3  diagnostic and treatment center licensed under article  twenty-eight  of
     4  the public health law which is affiliated with an academic dental center
     5  and  which has been granted an operating certificate pursuant to article
     6  twenty-eight of the public health law to provide such  dental  services.
     7  Any  diagnostic  and treatment center providing dental services pursuant

     8  to this clause shall prior to June first of  each  year  report  to  the
     9  governor,  temporary president of the senate and speaker of the assembly
    10  on the following: the total number of visits made by medical  assistance
    11  recipients during the immediately preceding calendar year; the number of
    12  visits  made  by  medical  assistance  recipients during the immediately
    13  preceding calendar year by recipients who were enrolled in managed  care
    14  programs;  the  number  of  visits made by medical assistance recipients
    15  during the immediately preceding calendar year by  recipients  who  were
    16  enrolled  in  managed  care  programs  that provide dental benefits as a
    17  covered service; and the number of visits made by the  uninsured  during

    18  the immediately preceding calendar year]; or
    19    (E)  the  services  are optometric services, as defined in article one
    20  hundred forty-three of the education law, and are provided by a diagnos-
    21  tic and treatment center licensed  under  article  twenty-eight  of  the
    22  public  health  law which is affiliated with the college of optometry of
    23  the state university of New York and which has been granted an operating
    24  certificate pursuant to article twenty-eight of the public health law to
    25  provide such optometric services. Any diagnostic  and  treatment  center
    26  providing  optometric  services  pursuant  to this clause shall prior to
    27  June first of each year report to the governor, temporary  president  of
    28  the  senate  and  speaker  of  the assembly on the following:  the total
    29  number of visits made by medical assistance recipients during the  imme-

    30  diately  preceding  calendar  year; the number of visits made by medical
    31  assistance recipients during the immediately preceding calendar year  by
    32  recipients  who  were  enrolled  in managed care programs; the number of
    33  visits made by medical  assistance  recipients  during  the  immediately
    34  preceding  calendar year by recipients who were enrolled in managed care
    35  programs that provide optometric benefits as a covered service; and  the
    36  number  of visits made by the uninsured during the immediately preceding
    37  calendar year; or
    38    (F) other services as defined by the commissioner of health.
    39    § 2. The department of health shall analyze and compare  expenditures,
    40  utilization  rates  and  utilization patterns for dental services (along
    41  with any related effects on expenditures, rates and patterns  for  other
    42  services) for medical assistance recipients; for the period during which

    43  medical  assistance  reimbursement for such services was included in the
    44  state rate of payment for medicaid  managed  care  and  for  the  period
    45  beginning  with  the  date on which medical assistance reimbursement for
    46  such services was no longer included in the state rate  of  payment  for
    47  medicaid managed care.
    48    The  department  of  health  shall include in its analyses and compar-
    49  isons, the expenditures, utilization rates and utilization patterns  for
    50  dental  services  (along with any related effects on expenditures, rates
    51  and patterns for other services) paid for by private third-party payors.
    52    The department of health shall report its findings  to  the  governor,
    53  the temporary president of the senate and the speaker of the assembly by
    54  December first, two thousand eleven.
    55    § 3. This act shall take effect on the one hundred twentieth day after

    56  it  shall  have  become a law, provided, however, that the amendments to
        A. 1720--B                          3
 
     1  subparagraph (iii) of paragraph (a) of subdivision 4 of section 364-j of
     2  the social services law made by section one of this act shall not affect
     3  the repeal of such section, as provided by section 11 of chapter 710  of
     4  the  laws of 1988, as amended, and shall be deemed to be repealed there-
     5  with.