S T A T E   O F   N E W   Y O R K
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                                  3487

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                            January 25, 2011
                               ___________

Introduced by M. of A. WRIGHT -- read once and referred to the Committee
  on Social Services

AN  ACT  to  amend  the social services law, in relation to limiting the
  method of payment for dental services  under  the  medical  assistance
  program;  and providing for the repeal of such provisions upon expira-
  tion thereof

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. The social services law is amended by adding a new section
365-l to read as follows:
  S 365-L.  PAYMENTS  FOR  DENTAL  SERVICES.  PAYMENTS  FOR  ALL  DENTAL
SERVICES AUTHORIZED PURSUANT TO SUBDIVISION TWO OF SECTION THREE HUNDRED
SIXTY-FIVE-A  OF  THIS  TITLE  SHALL  NOT  BE INCLUDED IN THE CAPITATION
PAYMENT FOR SERVICES OR SUPPLIES PROVIDED TO MEDICAL ASSISTANCE  RECIPI-
ENTS  BY  A  HEALTH  MAINTENANCE  ORGANIZATION  OR OTHER ENTITY WHICH IS
CERTIFIED UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR  LICENSED
PURSUANT  TO  ARTICLE  FORTY-THREE  OF  THE  INSURANCE  LAW OR OTHERWISE
AUTHORIZED BY LAW  TO  OFFER  COMPREHENSIVE  HEALTH  SERVICES  PLANS  TO
MEDICAL ASSISTANCE RECIPIENTS.
  S  2.  Section 367-a of the social services law is amended by adding a
new subdivision 13 to read as follows:
  13. NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
THE CONTRARY, FOR ALL DENTAL SERVICES FOR WHICH  PAYMENT  IS  AUTHORIZED
PURSUANT  TO  SUBDIVISION  TWO  OF SECTION THREE HUNDRED SIXTY-FIVE-A OF
THIS TITLE, PAYMENTS UNDER THIS TITLE SHALL BE  MADE  AT  THE  FOLLOWING
AMOUNT:  FOR  ALL DENTAL SERVICES PROVIDED BY DENTISTS AND OTHER AUTHOR-
IZED DENTAL PRACTITIONERS UNDER TITLE VIII OF THE EDUCATION LAW AND  FOR
ALL  DENTAL  APPLIANCES,  THE  ACTUAL  COST  OF SUCH DENTAL SERVICES AND
DENTAL APPLIANCES SUBJECT  TO  THE  MAXIMUM  LIMIT  ESTABLISHED  BY  THE
DEPARTMENT  OF  HEALTH  FOR  THOSE DENTAL SERVICES AND DENTAL APPLIANCES
COVERED UNDER THE MEDICAL ASSISTANCE PROGRAM.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06946-01-1
              

A. 3487                             2

  S 3. The social services law is amended by adding a new section  369-a
to read as follows:
  S  369-A.  ANALYSIS OF DENTAL EXPENDITURES AND PATTERNS IN RELATION TO
THE MEDICAL ASSISTANCE  PROGRAM.  1.  THE  DEPARTMENT  OF  HEALTH  SHALL
ANALYZE  AND  COMPARE  EXPENDITURES,  UTILIZATION  RATES AND UTILIZATION
PATTERNS FOR ALL DENTAL SERVICES AND DENTAL APPLIANCES (ALONG  WITH  ANY
RELATED  EFFECTS ON EXPENDITURES, RATES AND PATTERNS FOR OTHER SERVICES)
FOR MEDICAL ASSISTANCE RECIPIENTS:
  (A) FOR THE PERIOD DURING WHICH MEDICAL ASSISTANCE  REIMBURSEMENT  FOR
SUCH  DENTAL  SERVICES  AND  DENTAL APPLIANCES WAS PROVIDED PRIOR TO THE
EFFECTIVE DATE OF THIS SECTION; AND
  (B) FOR THE PERIOD BEGINNING WITH THE DATE ON WHICH MEDICAL ASSISTANCE
REIMBURSEMENT  FOR  SUCH  DENTAL  SERVICES  AND  DENTAL  APPLIANCES  WAS
PROVIDED AFTER THE EFFECTIVE DATE OF THIS SECTION.
  2.  THE DEPARTMENT OF HEALTH SHALL INCLUDE IN ITS ANALYSES AND COMPAR-
ISONS, THE EXPENDITURES, UTILIZATION RATES AND UTILIZATION PATTERNS  FOR
ALL  DENTAL  SERVICES  AND  DENTAL  APPLIANCES  (ALONG  WITH ANY RELATED
EFFECTS ON EXPENDITURES, RATES AND PATTERNS FOR OTHER SERVICES) PAID FOR
BY PRIVATE THIRD-PARTY PAYORS.
  3. 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 THIRTY-FIRST, TWO THOUSAND TWELVE.
  S 4. This act shall take effect on the one hundred twentieth day after
it shall have become a law, and shall  expire  and  be  deemed  repealed
March 31, 2014.