Bill Text: NY A02824 | 2013-2014 | General Assembly | Introduced
Bill Title: Provides for the allocation of monies for dental health services in the medicaid managed care program, the child health insurance program and the family health plus program.
Spectrum: Partisan Bill (Democrat 7-0)
Status: (Introduced - Dead) 2014-01-08 - referred to health [A02824 Detail]
Download: New_York-2013-A02824-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
2824
2013-2014 Regular Sessions
I N A S S E M B L Y
January 18, 2013
___________
Introduced by M. of A. WRIGHT, JAFFEE, CASTRO -- Multi-Sponsored by --
M. of A. BOYLAND, BRENNAN, GLICK, HEASTIE, WEISENBERG -- read once and
referred to the Committee on Health
AN ACT to amend the public health law and the social services law, in
relation to allocating monies for dental health services in the medi-
caid managed care program, the child health insurance program, and the
family health plus program
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Section 2511 of the public health law is amended by adding
2 a new subdivision 21 to read as follows:
3 21. EVERY APPROVED ORGANIZATION THAT PROVIDES COVERAGE FOR ANY DENTAL
4 SERVICE SHALL SPEND NOT LESS THAN EIGHTY PERCENT OF THE CAPITATION OR
5 OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR DENTAL SERVICES,
6 WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
7 FOR THE PROVISION OF DENTAL SERVICES TO PATIENTS BY LICENSED DENTISTS.
8 IN THE EVENT THE APPROVED ORGANIZATION SPENDS LESS THAN EIGHTY PERCENT
9 OF THE CAPITATION OR OTHER STATE FUNDS PAID TO IT FOR DENTAL SERVICES,
10 WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
11 FOR THE PROVISION OF DENTAL SERVICES, THE DIFFERENCE SHALL BE RETURNED
12 TO THE DEPARTMENT. IN NO EVENT SHALL MORE THAN TWENTY PERCENT OF THE
13 CAPITATION OR OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR
14 DENTAL SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER
15 DIRECTLY OR INDIRECTLY, BE SPENT BY ANY APPROVED ORGANIZATION ON ADMIN-
16 ISTRATIVE SERVICES IN LIEU OF DENTAL SERVICES FOR PATIENTS. THE DEPART-
17 MENT SHALL PROVIDE AN APPROVED ORGANIZATION WITH A CERTIFICATION LETTER
18 INDICATING THE AMOUNT OF CAPITATION OR OTHER STATE FUNDS PAID FOR DENTAL
19 SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR
20 INDIRECTLY, DURING EACH YEAR PURSUANT TO THIS SECTION.
21 S 2. Section 364-j of the social services law is amended by adding a
22 new subdivision 27 to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00726-01-3
A. 2824 2
1 27. EVERY MANAGED CARE PROVIDER AND MANAGED CARE PROGRAM THAT PROVIDES
2 COVERAGE FOR ANY DENTAL SERVICE SHALL SPEND NOT LESS THAN EIGHTY PERCENT
3 OF THE CAPITATION OR OTHER STATE FUNDS PAID TO THE MANAGED CARE PROVIDER
4 OR MANAGED CARE PROGRAM FOR DENTAL SERVICES, WHETHER AS A PREMIUM OR IN
5 ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY, FOR THE PROVISION OF
6 DENTAL SERVICES TO PATIENTS BY LICENSED DENTISTS. IN THE EVENT THE
7 MANAGED CARE PROVIDER OR MANAGED CARE PROGRAM SPENDS LESS THAN EIGHTY
8 PERCENT OF THE CAPITATION OR OTHER STATE FUNDS PAID TO IT FOR DENTAL
9 SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR
10 INDIRECTLY, FOR THE PROVISION OF DENTAL SERVICES, THE DIFFERENCE SHALL
11 BE RETURNED TO THE DEPARTMENT. IN NO EVENT SHALL MORE THAN TWENTY
12 PERCENT OF THE CAPITATION OR OTHER STATE FUNDS PAID TO THE MANAGED CARE
13 PROVIDER OR MANAGED CARE PROGRAM FOR DENTAL SERVICES, WHETHER AS A
14 PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY, BE SPENT BY
15 ANY MANAGED CARE PROVIDER OR MANAGED CARE PROGRAM ON ADMINISTRATIVE
16 SERVICES IN LIEU OF DENTAL SERVICES FOR PATIENTS. THE DEPARTMENT SHALL
17 PROVIDE A MANAGED CARE PROVIDER AND MANAGED CARE PROGRAM WITH A CERTIF-
18 ICATION LETTER INDICATING THE AMOUNT OF CAPITATION OR OTHER STATE FUNDS
19 PAID FOR DENTAL SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM
20 EITHER DIRECTLY OR INDIRECTLY, DURING EACH YEAR PURSUANT TO THIS
21 SECTION.
22 S 3. Section 369-ee of the social services law is amended by adding a
23 new subdivision 8 to read as follows:
24 8. EVERY APPROVED ORGANIZATION THAT PROVIDES COVERAGE FOR ANY DENTAL
25 SERVICE SHALL SPEND NOT LESS THAN EIGHTY PERCENT OF THE CAPITATION OR
26 OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR DENTAL SERVICES,
27 WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
28 FOR THE PROVISION OF DENTAL SERVICES TO PATIENTS BY LICENSED DENTISTS.
29 IN THE EVENT THE APPROVED ORGANIZATION SPENDS LESS THAN EIGHTY PERCENT
30 OF THE CAPITATION OR OTHER STATE FUNDS PAID TO IT FOR DENTAL SERVICES,
31 WHETHER AS A PREMIUM OR IN ANY OTHER FORM DIRECTLY OR INDIRECTLY, FOR
32 THE PROVISION OF DENTAL SERVICES, THE DIFFERENCE SHALL BE RETURNED TO
33 THE DEPARTMENT. IN NO EVENT SHALL MORE THAN TWENTY PERCENT OF THE CAPI-
34 TATION OR OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR DENTAL
35 SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR
36 INDIRECTLY, BE SPENT BY ANY APPROVED ORGANIZATION ON ADMINISTRATIVE
37 SERVICES IN LIEU OF DENTAL SERVICES FOR PATIENTS. THE DEPARTMENT SHALL
38 PROVIDE AN APPROVED ORGANIZATION WITH A CERTIFICATION LETTER INDICATING
39 THE AMOUNT OF CAPITATION OR OTHER STATE FUNDS PAID FOR DENTAL SERVICES,
40 WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
41 DURING EACH YEAR PURSUANT TO THIS SECTION.
42 S 4. This act shall take effect January 1, 2014, provided, however,
43 that the amendments to section 364-j of the social services law made by
44 section two of this act shall not affect the repeal of such section and
45 shall be deemed repealed therewith.
