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
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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
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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.
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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.
