Limits the method of payment for dental services under the medical assistance program

Summary of specific provisions

Bill Section 1 would add a new Section 365-i of the Social Services Law that would require that Medicaid reimbursement paid to authorized providers for dental services to patients in capitated programs shall be the same reimbursement paid for dental services to patients who are not in capitated programs.

Bill Section 2 would amend Section 367-a of the Social Services Law by adding a new subdivision 11 to require that all dental services provided through the Medicaid program be separately paid for at the actual cost of such services, subject to maximum limits set by the Department of Health.

Bill Section 3 would add a new Section 369-a of the Social Services Law that would require providing for an analysis of dental expenditures and utilization patterns in relation to the Medicaid program, with e report to the Governor and the Legislature on the findings.

Bill Section 4 would provide that the law take effect 120 days after it shall have become a law, and that the law will expire and be repealed effective March 31, 2013.

Justification

This legislation clarifies that dental reimbursement shall be carved out attic. Medicaid program for a period of approximate- ly two years and administered as a separate benefit at the actual cost of dental services, subject to maximum limitations established by the Department of Health. Dental reimbursement shall not be capitated and shall remain in the fee-for-service market for Medicaid. This carve-out of dental Medicaid services will enhance Medicaid recipients' access to quality care and will result in a net long-term savings to the Medicaid system for the cost of dental services. The dental Medicaid program has enabled many Medicaid recipients to establish a critical dentist-patient relationship, a relationship which enhances the quality of health care and prevents more costly procedures, emergency roam utilization, and hospitalization related to dental disease.

The bill, in addition to fostering access to quality care, also will allow the stale to realize substantial savings in the Medicaid dental program. This is because the bill provides for separate administration of dental Medicaid benefits on an actual cost basis, subject to maximum limitations to be set by the Department of Health. The Department of

Health will be able to control dental Medicaid costs very directly in this way. As a result, this bill authorizes the Department of Health to rely on its superior rate-setting methodologies to cap dental costs in the fee-for-service market. Similarly, the bill authorizes using utili- zation review programs to study and track expenditures, which have been successful in containing and controlling unnecessary costs. The State's utilization review programs are more comprehensive and efficient than many private market utilization review organizations. The State utiliza- tion review program, which can intercept duplicate claims and other inappropriate claims, generates significant savings. The State could, with relative ease, ultimately share its utilization data with Medicaid dental managed care plans so ensure that all Medicaid recipients receive properly coordinated, quality dental care.

The March 31, 2013 sunset provision, together with the provisions requiring evaluation of the program and a report of the findings to the Legislature and Governor by December 31, 2011, will make certain that the Medicaid payment method for dental services is adequately monitored. Consequently, the state will remain well positioned to implement any necessary changes in this payment method to ensure that New York's Medi- caid recipients continue to receive high quality dental care in a cost effective manner. Finally, the effective date of 120 days from the time it shall have become a law gives the State sufficient time so that Medi- caid recipients can continue to receive necessary dental services with- out any administrative disruptions.

Prior legislative history

None.

Fiscal implications

To be determined

Effective date

The bill takes effect 120 days after it shall have become a law, and the law will expire and be repealed effective March 31, 2013.