S07095 Summary:

BILL NOS07095
 
SAME ASNo Same As
 
SPONSORREICHLIN-MELNICK
 
COSPNSR
 
MLTSPNSR
 
Amd §§2807-t, 2557, 2559 & 2550, add §2807-o, rpld §2543 sub 3, Pub Health L; rpld §3235-a, §3216 sub§ (i) ¶25 sub¶ (F), §3221 sub§ (l) ¶17 sub¶ (F), §4303, sub§ (ee) ¶6, Ins L
 
Relates to early intervention and existing covered lives assessment funding.
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S07095 Actions:

BILL NOS07095
 
05/28/2021REFERRED TO HEALTH
01/05/2022REFERRED TO HEALTH
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S07095 Committee Votes:

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S07095 Floor Votes:

There are no votes for this bill in this legislative session.
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S07095 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          7095
 
                               2021-2022 Regular Sessions
 
                    IN SENATE
 
                                      May 28, 2021
                                       ___________
 
        Introduced  by  Sen. REICHLIN-MELNICK -- read twice and ordered printed,
          and when printed to be committed to the Committee on Health
 
        AN ACT to amend the public health law, in relation to early intervention
          and existing covered lives assessment funding; and to  repeal  certain
          provisions  of  the  public  health law and the insurance law relating
          thereto
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Paragraph  (b)  of subdivision 6 of section 2807-t of the
     2  public health law, as amended by section 13 of part Y of chapter  56  of
     3  the laws of 2020, is amended to read as follows:
     4    (b)  Notwithstanding  the provisions of paragraph (a) of this subdivi-
     5  sion, for covered lives assessment rate periods  on  and  after  January
     6  first,  two thousand fifteen through December thirty-first, two thousand
     7  twenty-three, for amounts collected in the aggregate in  excess  of  one
     8  billion  forty-five  million  dollars  on  an  annual basis, prospective
     9  adjustments shall be suspended if the annual reconciliation  calculation
    10  from the prior year would otherwise result in a decrease to the regional
    11  allocation of the specified gross annual payment amount for that region,
    12  provided,  however, that such suspension shall be lifted upon a determi-
    13  nation by the commissioner, in consultation with  the  director  of  the
    14  budget,  that:  (i)  as  a first priority, sixty-five million dollars in
    15  aggregate collections on an annual basis  over  and  above  one  billion
    16  forty-five million dollars on an annual basis have been reserved and set
    17  aside  for  deposit  in  the  HCRA  resources fund; and (ii) as a second
    18  priority, that twenty million dollars in  aggregate  collections  on  an
    19  annual  basis over and above one billion one hundred million dollars, on
    20  an annual basis have been reserved and set aside for deposit in the HCRA
    21  resources fund for  purposes  of  payments  to  the  early  intervention
    22  services  pool, pursuant to section twenty-eight hundred seven-o of this
    23  article.  Any amounts collected in the aggregate at or below one billion
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11665-01-1

        S. 7095                             2
 
     1  forty-five million dollars on an  annual  basis,  shall  be  subject  to
     2  regional  adjustments  reconciling  any  decreases  or  increases to the
     3  regional allocation in accordance with paragraph (a)  of  this  subdivi-
     4  sion.
     5    §  2.  The public health law is amended by adding a new section 2807-o
     6  to read as follows:
     7    § 2807-o. Early intervention services pool. 1. Definitions. As used in
     8  this section, the following terms shall have the following meanings:
     9    (a) "Early intervention services" shall mean services delivered to  an
    10  eligible  child, pursuant to an individualized family service plan under
    11  the early intervention program.
    12    (b) "Early intervention program" shall  mean  the  early  intervention
    13  program for toddlers with disabilities and their families, as created by
    14  title two-A of article twenty-five of this chapter.
    15    (c)  "Municipality"  shall  mean any county outside of the city of New
    16  York or the city of New York.
    17    2. Payments for early  intervention  services.  (a)  The  commissioner
    18  shall,  from  funds  allocated  for  such purpose under paragraph (b) of
    19  subdivision six of section twenty-eight hundred seven-t of this article,
    20  make payments to municipalities and the state for the delivery of  early
    21  intervention services.
    22    (b)  Payments  under  this subdivision shall be made to municipalities
    23  and the state by the commissioner. Each municipality and  the  state  of
    24  New York shall receive a share of such payments based on available fund-
    25  ing,  covered  lives  assessment equal to its proportionate share of the
    26  total approved statewide dollars not reimbursable by the medical assist-
    27  ance program paid to providers of early  intervention  services  by  the
    28  state  and  municipalities  on account of early intervention services in
    29  the last complete state fiscal year for which such data is available.
    30    § 3. Subdivision 1 of section  2557  of  the  public  health  law,  as
    31  amended  by  section  4  of  part C of chapter 1 of the laws of 2002, is
    32  amended to read as follows:
    33    1. The approved costs for an eligible child who receives an evaluation
    34  and early intervention services pursuant to this title shall be a charge
    35  upon the municipality wherein the eligible child resides or,  where  the
    36  services  are covered by the medical assistance program, upon the social
    37  services district of fiscal responsibility with respect to those  eligi-
    38  ble  children who are also eligible for medical assistance. All approved
    39  costs shall be paid in the first instance and at least quarterly by  the
    40  appropriate  governing body or officer of the municipality upon vouchers
    41  presented and audited in the same manner as the  case  of  other  claims
    42  against  the  municipality.  Notwithstanding  the insurance law or regu-
    43  lations thereunder relating to the permissible exclusion of payments for
    44  services under governmental programs, no such exclusion shall apply with
    45  respect to payments made pursuant to  this  title.  Notwithstanding  the
    46  insurance  law  or  any other law or agreement to the contrary, benefits
    47  under this title shall be considered secondary to [any plan of insurance
    48  or state government benefit] the medical assistance program under  which
    49  an  eligible  child  may  have  coverage. [Nothing in this section shall
    50  increase or enhance coverages provided for within an insurance  contract
    51  subject to the provisions of this title.]
    52    §  4.  Subdivision  2  of  section  2557  of the public health law, as
    53  amended by section 9-a of part A of chapter 56 of the laws of  2012,  is
    54  amended to read as follows:
    55    2. The department shall reimburse the approved costs paid by a munici-
    56  pality  for the purposes of this title, other than those reimbursable by

        S. 7095                             3
 
     1  the medical assistance program [or by third party payors], in an  amount
     2  of fifty percent of the amount expended in accordance with the rules and
     3  regulations   of  the  commissioner;  provided,  however,  that  in  the
     4  discretion  of  the  department and with the approval of the director of
     5  the division of the budget, the department may reimburse  municipalities
     6  in  an  amount  greater  than fifty percent of the amount expended. Such
     7  state reimbursement to the municipality shall not be paid prior to April
     8  first of the year in which the approved costs are paid  by  the  munici-
     9  pality,  provided, however that, subject to the approval of the director
    10  of the budget, the department may pay such state  aid  reimbursement  to
    11  the municipality prior to such date.
    12    §  5.  Paragraph  (b)  of  subdivision 5 of section 2557 of the public
    13  health law, as amended by section 9-a of part A of  chapter  56  of  the
    14  laws of 2012, is amended to read as follows:
    15    (b)  Notwithstanding any inconsistent provision of section one hundred
    16  twelve or one hundred sixty-three of the state finance law, sections one
    17  hundred forty-two and one hundred forty-three of the  economic  develop-
    18  ment  law,  or  any other contrary provision of law, the commissioner is
    19  authorized to enter into a contract or contracts under paragraph (a)  of
    20  this subdivision without a competitive bid or request for proposal proc-
    21  ess, provided, however, that:
    22    (i)  The department shall post on its website, for a period of no less
    23  than thirty days:
    24    (1) A description of the proposed services to be provided pursuant  to
    25  the contract or contracts;
    26    (2) The criteria for selection of a contractor or contractors;
    27    (3)  The period of time during which a prospective contractor may seek
    28  selection, which shall be no less than thirty days after  such  informa-
    29  tion is first posted on the website; and
    30    (4)  The  manner  by  which  a  prospective  contractor  may seek such
    31  selection, which may include submission by electronic means;
    32    (ii) All reasonable and responsive submissions that are received  from
    33  prospective  contractors  in  a  timely fashion shall be reviewed by the
    34  commissioner; [and]
    35    (iii) Such fiscal agent contractor shall pay claims in accordance with
    36  the timeframes included in section thirty-two hundred  twenty-four-a  of
    37  the insurance law, provided that such fiscal agent develop processes for
    38  the processing of claims which have minor errors where the liability and
    39  amount to be paid is clear; and
    40    (iv)  The  commissioner  shall  select  such contractor or contractors
    41  that, in his or her discretion, are best suited to serve the purposes of
    42  this section.
    43    § 6. The section heading of section 2559 of the public health law,  as
    44  added by chapter 428 of the laws of 1992, is amended to read as follows:
    45    [Third   party  insurance  and  medical]  Medical  assistance  program
    46  payments.
    47    § 7. Subdivision 3 of section 2559 of the public health law, as  added
    48  by  chapter  428  of  the  laws  of 1992, paragraphs (a), (c) and (d) as
    49  amended by section 11 of part A of chapter 56 of the laws  of  2012  and
    50  paragraph  (b) as further amended by section 104 of part A of chapter 62
    51  of the laws of 2011, is amended to read as follows:
    52    3. (a) [Providers of  evaluations  and  early  intervention  services,
    53  hereinafter  collectively  referred to in this subdivision as "provider"
    54  or "providers", shall in the first instance and where  applicable,  seek
    55  payment  from  all  third  party  payors including governmental agencies
    56  prior to claiming payment from  a  given  municipality  for  evaluations

        S. 7095                             4

     1  conducted  under the program and for services rendered to eligible chil-
     2  dren, provided that, the obligation to seek payment shall not apply to a
     3  payment from a third party payor who is  not  prohibited  from  applying
     4  such  payment,  and  will  apply  such payment, to an annual or lifetime
     5  limit specified in the insured's policy.
     6    (i) Parents shall provide the  municipality  and  service  coordinator
     7  information  on  any  insurance  policy, plan or contract under which an
     8  eligible child has coverage.
     9    (ii)] Parents shall provide the municipality and the service coordina-
    10  tor with a written referral from a primary care provider  as  documenta-
    11  tion,  for  eligible  children, of the medical necessity of early inter-
    12  vention services.
    13    [(iii) providers] (b) Providers shall utilize the department's  fiscal
    14  agent  and data system for claiming payment for evaluations and services
    15  rendered under the early  intervention  program,  provided  such  fiscal
    16  agent  complies  with  the  requirements  of subdivision five of section
    17  twenty-five hundred fifty-seven of this title.
    18    [(b) The commissioner, in consultation with the director of budget and
    19  the superintendent of financial services, shall  promulgate  regulations
    20  providing  public reimbursement for deductibles and copayments which are
    21  imposed under an insurance policy or health benefit plan to  the  extent
    22  that  such  deductibles  and  copayments  are applicable to early inter-
    23  vention services.
    24    (c) Payments made for early intervention services under  an  insurance
    25  policy  or  health  benefit plan, including payments made by the medical
    26  assistance program or other governmental third party  payor,  which  are
    27  provided  as  part  of  an  IFSP pursuant to section twenty-five hundred
    28  forty-five of this title shall not be applied by  the  insurer  or  plan
    29  administrator against any maximum lifetime or annual limits specified in
    30  the  policy  or  health benefits plan, pursuant to section eleven of the
    31  chapter of the laws of nineteen  hundred  ninety-two  which  added  this
    32  title.
    33    (d)]  (c)  A  municipality,  or  its designee, and a provider shall be
    34  subrogated, to the extent of the expenditures by  such  municipality  or
    35  for  early intervention services furnished to persons eligible for bene-
    36  fits under this title, to any rights such person may have or be entitled
    37  to from [third party reimbursement] the medical assistance program.  The
    38  provider shall submit notice to the insurer or plan administrator of his
    39  or her exercise of such right of subrogation upon the provider's assign-
    40  ment as the early intervention service provider for the child. The right
    41  of  subrogation  does not attach to benefits paid or provided [under any
    42  health insurance policy or health benefits plan]  prior  to  receipt  of
    43  written  notice of the exercise of subrogation rights [by the insurer or
    44  plan administrator providing such benefits]. Notwithstanding any  incon-
    45  sistent provision of this title, except as provided for in this subdivi-
    46  sion,  no  third-party  payor  other than the medical assistance program
    47  shall be required to reimburse for early intervention services  provided
    48  pursuant to this title.
    49    §  8.  Subdivision  3  of  section  2543  of  the public health law is
    50  REPEALED.
    51    § 9. Section 3235-a of the insurance law is REPEALED.
    52    § 10. Subparagraph (F) of paragraph 25 of subsection  (i)  of  section
    53  3216 of the insurance law is REPEALED.
    54    §  11.  Subparagraph  (F) of paragraph 17 of subsection (l) of section
    55  3221 of the insurance law is REPEALED.

        S. 7095                             5
 
     1    § 12. Paragraph 6 of subsection (ee) of section 4303 of the  insurance
     2  law is REPEALED.
     3    § 13. Section 2550 of the public health law is amended by adding a new
     4  subdivision 4 to read as follows:
     5    4.  (a) The lead agency shall review the individualized family service
     6  plan (hereinafter referred to as "the IFSP") from the previous  calendar
     7  year,  determine the appropriateness of the care or service received and
     8  whether the service received  conforms  to  the  IFSP,  as  outlined  in
     9  section twenty-five hundred forty-five of this title.
    10    (b)  The agency shall review the number of visits and hours of service
    11  rendered and determine whether services were appropriate,  complete  and
    12  fulfilled the terms of the IFSP.
    13    (c)  The fiscal agent, in dispersing reimbursement funds to providers,
    14  shall first ensure that the claim submitted by providers is appropriate-
    15  ly billed and technically correct.
    16    § 14. This act shall take effect January 1, 2022;  provided,  however,
    17  that  the  amendments to section 2807-t of the public health law made by
    18  section one of this act shall not affect the expiration of such  section
    19  and  shall  be  deemed to expire therewith.   Effective immediately, the
    20  addition, amendment and/or repeal of any rule  or  regulation  necessary
    21  for  the implementation of this act on its effective date are authorized
    22  to be made and completed on or before such effective date.
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