STATE OF NEW YORK
________________________________________________________________________
6517--A
2013-2014 Regular Sessions
IN ASSEMBLY
April 4, 2013
___________
Introduced by M. of A. PAULIN, GOTTFRIED, CAHILL, CLARK, COOK, GALEF,
GUNTHER, JACOBS, JAFFEE, LIFTON, MARKEY, LAVINE, MAGNARELLI, DINOWITZ,
BENEDETTO -- Multi-Sponsored by -- M. of A. SWEENEY, WEISENBERG --
read once and referred to the Committee on Health -- recommitted to
the Committee on Health in accordance with Assembly Rule 3, sec. 2 --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee
AN ACT to amend the public health law, in relation to funding early
intervention services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The public health law is amended by adding a new section
2 2807-o to read as follows:
3 § 2807-o. Early intervention services pool. 1. Definitions. The
4 following words or phrases as used in this section shall have the
5 following meanings:
6 (a) "Early intervention services" shall mean services delivered to an
7 eligible child, pursuant to an individualized family service plan under
8 the early intervention program.
9 (b) "Early intervention program" shall mean the early intervention
10 program for toddlers with disabilities and their families as created by
11 title two-A of article twenty-five of this chapter.
12 (c) "Municipality" shall mean any county outside of the city of New
13 York or the city of New York.
14 2. Grants for early intervention services. (a) The commissioner shall,
15 from funds allocated for such purpose under paragraph (g) of subdivision
16 six of section twenty-eight hundred seven-s of this article, make grants
17 to municipalities for the delivery of early intervention services. Such
18 grants shall be deemed reimbursement from third party payors to such
19 municipalities and the state of New York for the purposes of the early
20 intervention program.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03039-03-4
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1 (b) Grants under this subdivision shall be awarded to municipalities
2 by the commissioner. Each municipality and the state of New York shall
3 receive a share of such grants equal to its proportionate share of the
4 total approved statewide dollars not reimbursable by the medical assist-
5 ance program paid to providers of early intervention services by the
6 state and municipalities on account of early intervention services in
7 the last complete state fiscal year for which such data is available.
8 § 2. Subdivision 6 of section 2807-s of the public health law is
9 amended by adding two new paragraphs (g) and (h) to read as follows:
10 (g) A further gross statewide amount for two thousand fifteen shall be
11 one hundred fifteen million dollars.
12 (h) The amount specified in paragraph (g) of this subdivision shall be
13 allocated among the municipalities and the state of New York based on
14 each municipality's share and the state's share of early intervention
15 program expenditures not reimbursable by the medical assistance program
16 for the latest twelve month period for which such data is available.
17 § 3. Subdivision 7 of section 2807-s of the public health law is
18 amended by adding a new paragraph (d) to read as follows:
19 (d) funds shall be added to the funds collected by the commissioner
20 for distribution in accordance with section twenty-eight hundred seven-o
21 of this article, in the following amount: one hundred fifteen million
22 dollars for the period January first, two thousand fifteen through
23 December thirty-first, two thousand fifteen.
24 § 4. Subdivision 1 of section 2557 of the public health law, as
25 amended by section 4 of part C of chapter 1 of the laws of 2002, is
26 amended to read as follows:
27 1. The approved costs for an eligible child who receives an evaluation
28 and early intervention services pursuant to this title shall be a charge
29 upon the municipality wherein the eligible child resides or, where the
30 services are covered by the medical assistance program, upon the social
31 services district of fiscal responsibility with respect to those eligi-
32 ble children who are also eligible for medical assistance. All approved
33 costs shall be paid in the first instance and at least quarterly by the
34 appropriate governing body or officer of the municipality upon vouchers
35 presented and audited in the same manner as the case of other claims
36 against the municipality. Notwithstanding the insurance law or regu-
37 lations thereunder relating to the permissible exclusion of payments for
38 services under governmental programs, no such exclusion shall apply with
39 respect to payments made pursuant to this title. Notwithstanding the
40 insurance law or any other law or agreement to the contrary, benefits
41 under this title shall be considered secondary to any [plan of insurance
42 or] state government benefit program under which an eligible child may
43 have coverage. [Nothing in this section shall increase or enhance cover-
44 ages provided for within an insurance contract subject to the provisions
45 of this title.]
46 § 5. Section 2557 of the public health law is amended by adding a new
47 subdivision 4 to read as follows:
48 4. The commissioner shall collect data, by municipality, on the early
49 intervention program authorized under this title for purposes of improv-
50 ing the efficiency, cost effectiveness, and quality of such program.
51 Such municipality data collection shall include but not be limited to:
52 (a) The number and ages of children enrolled in the early intervention
53 program;
54 (b) The total number of children, within a municipality, receiving a
55 single service, the percentage of those children by service type, and
56 the average frequency of visits per week for such service type;
A. 6517--A 3
1 (c) The total number of children, within a municipality, receiving
2 multiple services, the percentage of those children by service type, the
3 average frequency of visits per week for such service type and the aver-
4 age number of service types that each child receives;
5 (d) The number of New York state approved agencies, institutions, or
6 organizations providing early intervention services by service specialty
7 or specialties and the number of New York state approved independent
8 providers of early intervention services by service specialty or
9 specialties;
10 (e) The number and percentage of children receiving a single service
11 by type of New York state approved service provider, and the number and
12 percentage of children receiving multiple services by type of New York
13 state approved service provider;
14 (f) The overall number of New York state approved evaluators. The
15 number of approved evaluators who also provide services to early inter-
16 vention children they have evaluated;
17 (g) The number of families receiving family supportive services such
18 as family training, counseling, parent support groups, and respite;
19 (h) The types of clinical practice guidelines, evaluation tools and
20 testing instruments used by municipalities to establish eligibility or
21 need for early intervention services;
22 (i) Both service, cost and payment oversight mechanisms used by coun-
23 ties to ensure quality and efficient delivery of early intervention
24 services;
25 (j) The number of children that are covered by the medical assistance
26 program;
27 (k) The number of claims submitted to the medical assistance program
28 by municipality. The percentage of claims denied by the medical assist-
29 ance program. The reasons for the denials.
30 The commissioner shall collect and analyze such data elements to
31 determine service and utilization patterns and to enhance the depart-
32 ment's ongoing provision of program oversight and guidance. In addition,
33 the commissioner shall report for the period July first, two thousand
34 fifteen to December thirty-first, two thousand fifteen, and for each
35 calendar year thereafter, to the governor and the legislature, by March
36 first of each year, the information and analysis required by this subdi-
37 vision.
38 § 6. Subdivision 2 of section 2557 of the public health law, as
39 amended by section 9-a of part A of chapter 56 of the laws of 2012, is
40 amended to read as follows:
41 2. The department shall reimburse the approved costs paid by a munici-
42 pality for the purposes of this title, other than those reimbursable by
43 the medical assistance program [or by third party payors], in an amount
44 of fifty percent of the amount expended in accordance with the rules and
45 regulations of the commissioner; provided, however, that in the
46 discretion of the department and with the approval of the director of
47 the division of the budget, the department may reimburse municipalities
48 in an amount greater than fifty percent of the amount expended. Such
49 state reimbursement to the municipality shall not be paid prior to April
50 first of the year in which the approved costs are paid by the munici-
51 pality, provided, however that, subject to the approval of the director
52 of the budget, the department may pay such state aid reimbursement to
53 the municipality prior to such date.
54 § 7. The section heading of section 2559 of the public health law, as
55 added by chapter 428 of the laws of 1992, is amended to read as follows:
A. 6517--A 4
1 [Third party insurance and medical] Medical assistance program
2 payments.
3 § 8. Subdivision 3 of section 2559 of the public health law, as added
4 by chapter 428 of the laws of 1992, paragraphs (a), (c) and (d) as
5 amended by section 11 of part A of chapter 56 of the laws of 2012 and
6 paragraph (b) as further amended by section 104 of part A of chapter 62
7 of the laws of 2011, is amended to read as follows:
8 3. (a) Providers of evaluations and early intervention services, here-
9 inafter collectively referred to in this subdivision as "provider" or
10 "providers", shall in the first instance and where applicable, seek
11 payment from [all third party payors including governmental agencies]
12 the medical assistance program prior to claiming payment from a given
13 municipality for evaluations conducted under the program and for
14 services rendered to eligible children, provided that, the obligation to
15 seek payment shall not apply [to a payment from a third party payor who
16 is not prohibited from applying such payment, and will apply such
17 payment, to an annual or lifetime limit specified in the insured's poli-
18 cy] where the insured is not eligible for medical assistance pursuant to
19 the social services law.
20 (i) Parents shall provide the municipality and service coordinator
21 information on any insurance policy, plan or contract under which an
22 eligible child has coverage.
23 (ii) Parents shall provide the municipality and the service coordina-
24 tor with a written referral from a primary care provider as documenta-
25 tion, for eligible children, of the medical necessity of early inter-
26 vention services.
27 (iii) providers shall utilize the department's fiscal agent and data
28 system for claiming payment for evaluations and services rendered under
29 the early intervention program.
30 (b) [The commissioner, in consultation with the director of budget and
31 the superintendent of financial services, shall promulgate regulations
32 providing public reimbursement for deductibles and copayments which are
33 imposed under an insurance policy or health benefit plan to the extent
34 that such deductibles and copayments are applicable to early inter-
35 vention services.
36 (c) Payments made for early intervention services under an insurance
37 policy or health benefit plan, including payments made by the medical
38 assistance program or other governmental third party payor, which are
39 provided as part of an IFSP pursuant to section twenty-five hundred
40 forty-five of this title shall not be applied by the insurer or plan
41 administrator against any maximum lifetime or annual limits specified in
42 the policy or health benefits plan, pursuant to section eleven of the
43 chapter of the laws of nineteen hundred ninety-two which added this
44 title.
45 (d)] A municipality, or its designee, and a provider shall be subro-
46 gated, to the extent of the expenditures by such municipality or for
47 early intervention services furnished to persons eligible for benefits
48 under this title, to any rights such person may have or be entitled to
49 from [third party reimbursement] the medical assistance program. The
50 provider shall submit notice to the insurer or plan administrator of his
51 or her exercise of such right of subrogation upon the provider's assign-
52 ment as the early intervention service provider for the child. The right
53 of subrogation does not attach to benefits paid or provided [under any
54 health insurance policy or health benefits plan] prior to receipt of
55 written notice of the exercise of subrogation rights [by the insurer or
56 plan administrator providing such benefits]. Notwithstanding any incon-
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1 sistent provision of this title, except as provided for herein, no third
2 party payor other than the medical assistance program shall be required
3 to reimburse for early intervention services provided under this title.
4 § 9. This act shall take effect on the thirtieth day after it shall
5 have become a law; provided, however the amendments to section 2807-s of
6 the public health law made by sections two and three of this act shall
7 not affect the expiration of such section and shall be deemed to expire
8 therewith.
