S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3979
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 29, 2021
                                ___________
 
 Introduced  by M. of A. DICKENS -- read once and referred to the Commit-
   tee 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:
 
   Section  1. Section 2511 of the public health law is amended by adding
 a new subdivision 22 to read as follows:
   22. EVERY APPROVED ORGANIZATION THAT PROVIDES COVERAGE FOR ANY  DENTAL
 SERVICE  SHALL  SPEND  NOT LESS THAN EIGHTY PERCENT OF THE CAPITATION OR
 OTHER STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR DENTAL SERVICES,
 WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
 FOR THE PROVISION OF DENTAL SERVICES TO PATIENTS BY  LICENSED  DENTISTS.
 IN  THE  EVENT THE APPROVED ORGANIZATION SPENDS LESS THAN EIGHTY PERCENT
 OF THE CAPITATION OR OTHER STATE FUNDS PAID TO IT FOR  DENTAL  SERVICES,
 WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY,
 FOR  THE  PROVISION OF DENTAL SERVICES, THE DIFFERENCE SHALL BE RETURNED
 TO THE DEPARTMENT. IN NO EVENT SHALL MORE THAN  TWENTY  PERCENT  OF  THE
 CAPITATION  OR  OTHER  STATE FUNDS PAID TO THE APPROVED ORGANIZATION FOR
 DENTAL SERVICES, WHETHER AS A  PREMIUM  OR  IN  ANY  OTHER  FORM  EITHER
 DIRECTLY  OR INDIRECTLY, BE SPENT BY ANY APPROVED ORGANIZATION ON ADMIN-
 ISTRATIVE SERVICES IN LIEU OF DENTAL SERVICES FOR PATIENTS. THE  DEPART-
 MENT  SHALL PROVIDE AN APPROVED ORGANIZATION WITH A CERTIFICATION LETTER
 INDICATING THE AMOUNT OF CAPITATION OR OTHER STATE FUNDS PAID FOR DENTAL
 SERVICES, WHETHER AS A PREMIUM OR IN ANY OTHER FORM EITHER  DIRECTLY  OR
 INDIRECTLY, DURING EACH YEAR PURSUANT TO THIS SECTION.
   §  2.  Section 364-j of the social services law is amended by adding a
 new subdivision 40 to read as follows:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03706-01-1
              

 A. 3979                             2
 
   40. EVERY MANAGED CARE PROVIDER AND MANAGED CARE PROGRAM THAT PROVIDES
 COVERAGE FOR ANY DENTAL SERVICE SHALL SPEND NOT LESS THAN EIGHTY PERCENT
 OF THE CAPITATION OR OTHER STATE FUNDS PAID TO THE MANAGED CARE PROVIDER
 OR MANAGED CARE PROGRAM FOR DENTAL SERVICES, WHETHER AS A PREMIUM OR  IN
 ANY  OTHER  FORM  EITHER  DIRECTLY  OR  INDIRECTLY, FOR THE PROVISION OF
 DENTAL SERVICES TO PATIENTS BY LICENSED DENTISTS.    IN  THE  EVENT  THE
 MANAGED  CARE  PROVIDER  OR MANAGED CARE PROGRAM SPENDS LESS THAN EIGHTY
 PERCENT OF THE CAPITATION OR OTHER STATE FUNDS PAID  TO  IT  FOR  DENTAL
 SERVICES,  WHETHER  AS A PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR
 INDIRECTLY, FOR THE PROVISION OF DENTAL SERVICES, THE  DIFFERENCE  SHALL
 BE  RETURNED  TO  THE  DEPARTMENT.    IN NO EVENT SHALL MORE THAN TWENTY
 PERCENT OF THE CAPITATION OR OTHER STATE FUNDS PAID TO THE MANAGED  CARE
 PROVIDER  OR  MANAGED  CARE  PROGRAM  FOR  DENTAL SERVICES, WHETHER AS A
 PREMIUM OR IN ANY OTHER FORM EITHER DIRECTLY OR INDIRECTLY, BE SPENT  BY
 ANY  MANAGED  CARE  PROVIDER  OR  MANAGED CARE PROGRAM ON ADMINISTRATIVE
 SERVICES IN LIEU OF DENTAL SERVICES FOR PATIENTS. THE  DEPARTMENT  SHALL
 PROVIDE  A MANAGED CARE PROVIDER AND MANAGED CARE PROGRAM WITH A CERTIF-
 ICATION LETTER INDICATING THE AMOUNT OF CAPITATION OR OTHER STATE  FUNDS
 PAID  FOR  DENTAL  SERVICES,  WHETHER  AS A PREMIUM OR IN ANY OTHER FORM
 EITHER DIRECTLY  OR  INDIRECTLY,  DURING  EACH  YEAR  PURSUANT  TO  THIS
 SECTION.
   §  3.  This  act shall take effect January 1, 2022, provided, however,
 that the amendments to section 364-j of the social services law made  by
 section  two of this act shall not affect the repeal of such section and
 shall be deemed repealed therewith.