What's happening
This bill requires at least 80% of state funds for dental coverage in Medicaid and related programs be spent on actual dental services, limiting administrative costs to 20%.
Why it matters
Strengthens transparency and accountability. by requiring dental insurers and managed care providers in state programs to document and certify how Medicaid and related funds are spent, making it easier to track whether taxpayer dollars are being used for direct patient care.
Directly targets patient care improvement. by ensuring at least 80% of state funds actually support dental services provided by licensed dentists, which could lead to expanded access, more covered procedures, or higher provider reimbursement rates for patients in Medicaid, Child Health Plus, and Family Health Plus.
Discourages excessive administrative spending. by capping administrative costs at 20%, potentially curbing waste, overhead, or profit-taking by managed care organizations and insurers, and incentivizing them to prioritize patient services.
Includes a clawback mechanism. requiring organizations that underspend on actual dental care to return the difference to the state, creating a financial incentive to maximize spending on patient treatment rather than non-care costs.
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Require Medicaid Dental Spending
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History
- Referred to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Fund Dental Care Access
In Senate Committee · Health · Sponsor Leroy Comrie
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3362
2019-2020 Regular Sessions
IN ASSEMBLY
January 29, 2019
Introduced by M. of A. DICKENS -- 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 medicaid 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 Assembly, 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 administrative services in lieu of dental services for patients. The department 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 34 to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06500-01-9
A. 3362 2
34. 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 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.
§ 3. This act shall take effect January 1, 2020, 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.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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