What's happening
This bill expands Medicaid coverage to include nurse midwives, nurse practitioners, clinical psychologists, and audiologists, and limits routine dental care to hospital outpatient or clinic settings.
Why it matters
Expanding provider coverage under Medicaid. means patients will have more choices in where and from whom they receive primary and specialized care, potentially improving access for underserved populations and alleviating provider shortages in some areas.
Including services from nurse midwives, nurse practitioners, clinical psychologists, and audiologists in Medicaid. allows for more comprehensive and specialized care options, which can be especially important for maternal health, mental health, and hearing-impaired populations.
Restricting routine dental care to hospital outpatient or clinic settings. could reduce access for some Medicaid recipients who currently use private dental offices, possibly shifting where and how dental services are delivered and impacting both patient convenience and provider business models.
Authorizing prior approval for prescription drugs in nursing homes that aren’t part of the facility’s Medicaid rate. aims to control costs and ensure appropriate medication use, which could affect how quickly residents receive new prescriptions and potentially impact patient outcomes.
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Who cares
Medicaid dental patients and dentists
The bill would limit routine dental coverage to hospital outpatient or clinic settings and remove dental prosthetic appliances from the listed covered supplies.
Clinical psychologists, nurses and audiologists
The bill would place their services under referral and eligibility restrictions tied to early and periodic screening and diagnosis or qualified Medicare beneficiary status.
Nursing home residents and prescription drug providers
The bill would authorize the health commissioner to require prior approval for drugs prescribed to residents when those drugs are not reimbursed through the nursing home's Medicaid rate.
Nurse practitioners and nurse midwives
The bill would explicitly add their services to the general list of covered professional services.
Headline styles
Expand Medicaid Service Coverage
Plain English, a few words. Used as the page title.
Sponsors
1 Multi-sponsor
History
- Referred to health
- Referred to health
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2784
2019-2020 Regular Sessions
IN ASSEMBLY
January 25, 2019
Introduced by M. of A. SCHIMMINGER -- Multi-Sponsored by -- M. of A. RIVERA -- read once and referred to the Committee on Health
AN ACT to amend the social services law, in relation to the character and adequacy of Medicaid assistance and to repeal paragraph (n) of subdivision 2 of section 365-a of the social services law relating to the care and services of audiologists
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph (a) of subdivision 2 of section 365-a of the social services law, as amended by chapter 47 of the laws of 1996, is amended to read as follows:
(a) services of qualified physicians, [dentists, nurses, and private duty nursing services shall be further subject to the provisions of section three hundred sixty-seven-o of this chapter,] optometrists, nurse midwives, nurse practitioners, and other related professional personnel;
§ 2. Paragraph (f) of subdivision 2 of section 365-a of the social services law, as added by chapter 184 of the laws of 1969 and as relettered by chapter 478 of the laws of 1980, is amended to read as follows:
(f) preventive, prophylactic and other routine dental care, services and supplies only when provided in a hospital outpatient or clinic facility referred to in paragraph (c) of this subdivision;
§ 3. Paragraph (g) of subdivision 2 of section 365-a of the social services law, as amended by section 21 of part A of chapter 56 of the laws of 2013, is amended to read as follows:
(g) sickroom supplies, eyeglasses, and prosthetic appliances [and dental prosthetic appliances] furnished in accordance with the regulations of the department; provided further that: (i) the commissioner of health is authorized to implement a preferred diabetic supply program wherein the department of health will receive enhanced rebates from preferred manufacturers of glucometers and test strips, and may subject
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03834-01-9
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non-preferred manufacturers' glucometers and test strips to prior authorization under section two hundred seventy-three of the public health law; (ii) enteral formula therapy and nutritional supplements are limited to coverage only for nasogastric, jejunostomy, or gastrostomy tube feeding, for treatment of an inborn metabolic disorder, or to address growth and development problems in children, or, subject to standards established by the commissioner, for persons with a diagnosis of HIV infection, AIDS or HIV-related illness or other diseases and conditions; (iii) prescription footwear and inserts are limited to coverage only when used as an integral part of a lower limb orthotic appliance, as part of a diabetic treatment plan, or to address growth and development problems in children; (iv) compression and support stockings are limited to coverage only for pregnancy or treatment of venous stasis ulcers; [and] (v) the commissioner of health is authorized to implement an incontinence supply utilization management program to reduce costs without limiting access through the existing provider network, including but not limited to single or multiple source contracts or, a preferred incontinence supply program wherein the department of health will receive enhanced rebates from preferred manufacturers of incontinence supplies, and may subject non-preferred manufacturers' incontinence supplies to prior approval pursuant to regulations of the department, provided any necessary approvals under federal law have been obtained to receive federal financial participation in the costs of incontinence supplies provided pursuant to this subparagraph; and (vi) the commissioner of health is authorized to require prior approval of any prescription drug that is prescribed for a resident of a nursing home and that is not reimbursed as part of the nursing home's medicaid rate;
§ 4. Paragraph (l) of subdivision 2 of section 365-a of the social services law, as amended by chapter 81 of the laws of 1995, is amended to read as follows:
(l) care and services of podiatrists, clinical psychologists, nurses and audiologists, including such care and services provided in a hospital out-patient or clinic facility referred to in paragraph (c) of this subdivision, and dentists, which care and services shall only be provided upon referral by a physician, nurse practitioner or certified nurse midwife in accordance with the program of early and periodic screening and diagnosis established pursuant to subdivision three of this section or to persons eligible for benefits under title XVIII of the federal social security act as qualified medicare beneficiaries in accordance with federal requirements therefor [and private duty nurses which care and services shall only be provided in accordance with regulations of the department of health; provided, however, that private duty nursing services shall not be restricted when such services are more appropriate and cost-effective than nursing services provided by a home health agency pursuant to section three hundred sixty-seven-l];
§ 5. Paragraph (n) of subdivision 2 of section 365-a of the social services law, as added by chapter 556 of the laws of 1986, is REPEALED.
§ 6. The commissioner of health is authorized to promulgate or adopt any rules or regulations necessary to implement the provisions of this act and any procedures, forms, or instructions necessary for such implementation may be adopted and issued on or after the effective date of this act. Notwithstanding any inconsistent provision of the state administrative procedure act or any other provision of law, rule or regulation, the commissioner of health and the superintendent of financial services and any appropriate council is authorized to adopt or amend or
A. 2784 3
promulgate on an emergency basis any regulation he or she or such council determines necessary to implement any provision of this act on its effective date.
§ 7. This act shall take effect on the one hundred eightieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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