A00356 Summary:

BILL NOA00356
 
SAME ASSAME AS S03338
 
SPONSORPaulin
 
COSPNSRGottfried, Cahill, Cook, Galef, Gunther, Jaffee, Lifton, Magnarelli, Dinowitz, Benedetto, Lupardo, Abinanti, Crouch, Miller MG, Johns
 
MLTSPNSRLawrence
 
Add §2807-o, amd §§2807-s, 2557 & 2559, 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
 
Provides for state funding to municipalities for early intervention services for toddlers with disabilities and their families.
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A00356 Actions:

BILL NOA00356
 
01/09/2019referred to health
01/15/2019reported referred to ways and means
01/08/2020referred to ways and means
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A00356 Committee Votes:

HEALTH Chair:Gottfried DATE:01/15/2019AYE/NAY:25/0 Action: Favorable refer to committee Ways and Means
GottfriedAyeRaiaAye
SchimmingerExcusedMcDonoughAye
GalefAyeRaAye
DinowitzAyeGarbarinoAye
CahillAyeByrneAye
PaulinAyeByrnesAye
CymbrowitzAyeAshbyAye
GuntherAye
RosenthalAye
HevesiAye
JaffeeAye
SteckAye
AbinantiAye
BraunsteinAye
KimAye
SolagesAye
BichotteAye
BarronAye
SayeghAye

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A00356 Floor Votes:

There are no votes for this bill in this legislative session.
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A00356 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A356
 
SPONSOR: Paulin
  TITLE OF BILL: An act to amend the public health law, in relation to funding early intervention services; and to repeal certain provisions of the public health law and the insurance law relating thereto   PURPOSE OR GENERAL IDEA OF BILL: To provide a system that streamlines the process by which funds are distributed to municipalities to finance early intervention programs, thereby providing vital relief to the municipalities across the state, and to improve their ability to more effectively administer early inter- vention services to children who need such services.   SUMMARY OF SPECIFIC PROVISIONS: Section one amends the public health law by adding a new section 2807-o that provides definitions for terms used in this section of law. Section one also provides that the commissioner of health shall make payments to municipalities for the delivery of early intervention services. Such payments shall be a share of payments equal to the proportionate share of the municipality and the State, as the case may be, of the total approved statewide dollars not reimbursable by the medical assistance program paid by municipalities and the State to providers of early intervention services in the last complete state fiscal year for which such data is available. Section two amends subdivision 6 of section 2807-s of the public health law by adding two new paragraphs (g) and (h). Paragraph (g) provides that a further gross statewide amount for two thousand eighteen shall be fifteen million dollars. Paragraph (h) provides that the fifteen million dollars specified in paragraph (g) shall be allocated among the munici- palities and the State based on the share of each municipality and the State of early intervention program expenditures not reimbursable by the medical assistance program for the latest twelve month period for which such data is available. Section three amends subdivision 7 of section 2807-s of the public health law by adding a new paragraph (d) that provides that funds shall be added to the funds collected by the commissioner for distribution in accordance with section 2807-o, in the amount of fifteen million dollars for the period beginning April 1, 2019 and continuing each state fiscal year thereafter. Section four amends subdivision 1 of section 2557 of the public health law, as amended by section 4 of part C of chapter 1 of the laws of 2002, to delete the reference to a plan of insurance so that benefits under this title shall be considered secondary only to any state government benefit program under which an eligible child may have coverage, and to delete the provision that nothing in this section shall increase or enhance coverages provided for within an insurance contract subject to the provisions of this title. Section five amends subdivision 2 of section 2557 of the public health law to provide that the department shall reimburse the approved costs paid by a municipality other than those reimbursable by the medical assistance program, eliminating the exclusion of costs reimbursable by third party payors. Section six amends the section heading of section 2559 of the public health law, as added by chapter 428 of the laws of 1992, to eliminate the reference to third party insurance. Section seven amends subdivision 3 of section 2559 of the public health law, as added by chapter 428 of the laws of 1992, paragraphs (a), (c) and (d) as amended by section 11 of part A of chapter 56 of the laws of 2012 and paragraph b as further amended by section 104 of Part A of chapter 62 of the laws of 2011, to delete parts of paragraph (a). This section also deletes paragraphs (b) requiring the commissioner to promulgate regulations providing public reimbursement for deductibles and copayments imposed under an insurance policy or health benefit plan to the extent that such deductibles and copayments are applicable to early intervention services and (c) requiring that payments made for early intervention services under an insurance policy or health benefit plan provided as part of an IFSP shall not be applied against any maxi- mum lifetime or annual limits specified in the policy or health benefit plan. In addition, section seven provides that a municipality shall be subrogated to the extent of its expenditures for early intervention services furnished to eligible persons to the rights such person may have from the medical assistance program rather than from third party reimbursement. Except as provided in this article, no third party payor other than the medical assistance program shall be required to reimburse for early intervention services. Section eight repeals subdivision 3 of section 2543 of the public health law. Section nine repeals section 3235-a of the insurance law. Section ten repeals subparagraph (F) of paragraph 25 of subsection (i) of section 3216 of the insurance law. Section eleven repeals subparagraph (F) of paragraph 17 of subsection (1) of section 3221 of the insurance law. Section twelve repeals paragraph 6 of subsection (ee) of section 4303 of the insurance law. Section thirteen provides the effective date.   JUSTIFICATION: The early intervention program was established under the Public Health Law and the federal Individuals with Disabilities Education Act (IDEA) to enhance the development of infants and toddlers from birth to age three who have a significant developmental delay or disability, as well as enhance the capacity of families to meet their children's special needs. The program seeks to identify and evaluate as early as possible those infants and toddlers whose healthy development is compromised and to provide for appropriate therapeutic and supportive services. With early intervention, we can reduce the number of children with disabili- ties or reduce the severity of their disabling conditions. All early intervention (EI) services must be provided to eligible chil- dren at no cost to their families. The EI program is financed through a combination of state and county funds, Medicaid and commercial insur- ance. Counties, which are required by the State to finance and administer the EI program, are entitled to be reimbursed by the State for 50% of their unreimbursed costs for EI services (36% for administration costs). Although Public Health Law and IDEA mandate that public and private commercial insurance be maximized in financing FT services, reimburse- ment from third party payors, other than Medicaid, has been minimal, leaving the cost of this entitlement to be paid by state and municipal tax dollars. In 2013, implementation of a statewide fiscal agent was designed to increase third party reimbursement. Four years later, commercial payors still deny claims. Since EI claims billed to commercial insurance have decreased as a percentage of total claims - with more being billed to Medicaid - the dollar amount paid by commercial insurance has actually decreased since the state hired the fiscal agent. In 2017, approximately $70 million in claims was billed to commercial insurance with only about $11.5 million paid from about 1.1 million services rendered. As a result, 70% of the claims were denied. The partial funding by the State, combined with the low rate of recoup- ment from third party insurers, has required municipalities to bear an estimated 43% of the costs of providing EI services. Furthermore, the prolonged and systematic underfunding of EI providers has driven smaller providers out of business and led to provider consol- idation and increased wait times for parents. From 2012 to 2015, the New York City EI office saw a 910% increase in the number of calls from parents unable to find EI providers for children who qualified for services. Since a substantial portion of municipal budgets must be spent on EI services, municipalities must face a shrinking balance of available funds, forcing them to decrease or eliminate altogether other needed services. To require municipalities to bear such a significant portion of the costs of the program where the number of children served as well as the level of services provided continues to increase imposes a significant strain on local budgets. Recognizing that the current structure of financing El costs is inade- quate, this bill provides a different approach to funding. The bill would set up a statewide pool. from which municipalities and the State would be allocated funds to pay EI costs. This bill would use the covered lives assessment (a long-standing tax paid by health plans, including self-insured plans) to contribute to the cost of the program. Implementing this change would remove any obligation on insurers to pay for EI services and replace it with a lump sum payment, dramatically reducing the administrative burden on providers as well as on the plans themselves. For the first year, an amount of $15M would be paid into the pool. This amount is based on the approximate percentage commercial insurers pay of total EI program cost(utilizing data from the 2012-13 program year) increased by the estimated amount paid by commercial insurers related to mandated coverage for autism spectrum disorder. This direct allocation of funds to municipalities from the statewide pool will eliminate the unwieldy and inefficient step of requiring muni- cipalities (in the case where the insured is not eligible for medical assistance) to seek reimbursement of EI costs first from third party insurers and then, only upon denial or other disposition of the claim, from the State. In cases where the insured is eligible for medical assistance, municipalities will remain obligated to seek reimbursement first from the medical assistance program. Making funds readily available and streamlining the process by which the funds are distributed to municipalities and the State will provide vital relief to the State and the municipalities that have been struggling to finance the EI program. It will improve the administration of EI services to children who need those services.   PRIOR LEGISLATIVE HISTORY: A.2569A, 2017 and 2018, referred to ways and means. S. 1727-A, 2017 and 2018, referred to health. A.273A, 2015 and 2016, reported and referred to ways and means in both years. Same as S.4372-A, 2015 and 2016, referred to health. A.6517-A, 2013 and 2014 referred to health. A.812, 2011 and 2012 reported referred to ways and means. A.4058-A, 2009 reported referred to ways and means and 2010 held for consideration in ways and means. A.6814-A, 2007 and 2008, reported and referred to ways and means in both years.   FISCAL IMPLICATIONS: This bill will have no fiscal impact to the State and will in fact generate revenue to the State. The State currently bears approximately 97% of the total EI program costs, with commercial insurers paying 3%. The bill contemplates that commercial insurers will pay into a fund 15% of the program costs with the State and municipalities sharing such funded amount.   EFFECTIVE DATE: This act shall Lake effect the January after is becomes a law; provided, however the amendments to section 2807-s of the public health law made by sections two and three of this act shall not affect the expiration of such section and shall be deemed to expire therewith. Effective imme- diately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made by the commissioner of health, on or before such a date.
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A00356 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                           356
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 9, 2019
                                       ___________
 
        Introduced  by M. of A. PAULIN, GOTTFRIED, CAHILL, COOK, GALEF, GUNTHER,
          JAFFEE, LIFTON, MAGNARELLI, DINOWITZ,  BENEDETTO,  LUPARDO,  ABINANTI,
          CROUCH,  M. G. MILLER  --  read  once and referred to the Committee on
          Health
 
        AN ACT to amend the public health law,  in  relation  to  funding  early
          intervention  services; 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.  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.  Payments  for  early  intervention  services. (a) The commissioner
    15  shall, from funds allocated for such  purpose  under  paragraph  (g)  of
    16  subdivision six of section twenty-eight hundred seven-s of this article,
    17  make  payments to municipalities and the state for the delivery of early
    18  intervention services.
    19    (b) Payments under this subdivision shall be  made  to  municipalities
    20  and  the  state  by the commissioner. Each municipality and the state of
    21  New York shall receive a share of such payments  equal  to  its  propor-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00634-01-9

        A. 356                              2
 
     1  tionate  share  of the total approved statewide dollars not reimbursable
     2  by the medical assistance program paid  to  providers  of  early  inter-
     3  vention  services  by  the  state and municipalities on account of early
     4  intervention  services  in the last complete state fiscal year for which
     5  such data is available.
     6    § 2. Subdivision 6 of section 2807-s  of  the  public  health  law  is
     7  amended by adding two new paragraphs (g) and (h) to read as follows:
     8    (g)  A  further  gross  statewide amount for the state fiscal year two
     9  thousand twenty and each state fiscal year thereafter shall  be  fifteen
    10  million dollars.
    11    (h) The amount specified in paragraph (g) of this subdivision shall be
    12  allocated  under  section  twenty-eight  hundred seven-o of this article
    13  among the municipalities and the state of New York based on each munici-
    14  pality's share and the  state's  share  of  early  intervention  program
    15  expenditures  not reimbursable by the medical assistance program for the
    16  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: fifteen  million  dollars  for
    22  the  period  beginning  April first, two thousand twenty, and continuing
    23  each state fiscal year thereafter.
    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] the medical assistance program under  which
    43  an  eligible  child  may  have  coverage. [Nothing in this section shall
    44  increase or enhance coverages provided for within an insurance  contract
    45  subject to the provisions of this title.]
    46    §  5.  Subdivision  2  of  section  2557  of the public health law, as
    47  amended by section 9-a of part A of chapter 56 of the laws of  2012,  is
    48  amended to read as follows:
    49    2. The department shall reimburse the approved costs paid by a munici-
    50  pality  for the purposes of this title, other than those reimbursable by
    51  the medical assistance program [or by third party payors], in an  amount
    52  of fifty percent of the amount expended in accordance with the rules and
    53  regulations   of  the  commissioner;  provided,  however,  that  in  the
    54  discretion of the department and with the approval of  the  director  of
    55  the  division of the budget, the department may reimburse municipalities
    56  in an amount greater than fifty percent of  the  amount  expended.  Such

        A. 356                              3
 
     1  state reimbursement to the municipality shall not be paid prior to April
     2  first  of  the  year in which the approved costs are paid by the munici-
     3  pality, provided, however that, subject to the approval of the  director
     4  of  the  budget,  the department may pay such state aid reimbursement to
     5  the municipality prior to such date.
     6    § 6. The section heading of section 2559 of the public health law,  as
     7  added by chapter 428 of the laws of 1992, is amended to read as follows:
     8    [Third   party  insurance  and  medical]  Medical  assistance  program
     9  payments.
    10    § 7. Subdivision 3 of section 2559 of the public health law, as  added
    11  by  chapter  428  of  the  laws  of 1992, paragraphs (a), (c) and (d) as
    12  amended by section 11 of part A of chapter 56 of the laws  of  2012  and
    13  paragraph  (b) as further amended by section 104 of part A of chapter 62
    14  of the laws of 2011, is amended to read as follows:
    15    3. (a) [Providers of  evaluations  and  early  intervention  services,
    16  hereinafter  collectively  referred to in this subdivision as "provider"
    17  or "providers", shall in the first instance and where  applicable,  seek
    18  payment  from  all  third  party  payors including governmental agencies
    19  prior to claiming payment from  a  given  municipality  for  evaluations
    20  conducted  under the program and for services rendered to eligible chil-
    21  dren, provided that, the obligation to seek payment shall not apply to a
    22  payment from a third party payor who is  not  prohibited  from  applying
    23  such  payment,  and  will  apply  such payment, to an annual or lifetime
    24  limit specified in the insured's policy.
    25    (i) Parents shall provide the  municipality  and  service  coordinator
    26  information  on  any  insurance  policy, plan or contract under which an
    27  eligible child has coverage.
    28    (ii)] Parents shall provide the municipality and the service coordina-
    29  tor with a written referral from a primary care provider  as  documenta-
    30  tion,  for  eligible  children, of the medical necessity of early inter-
    31  vention services.
    32    [(iii) providers] (b) Providers shall utilize the department's  fiscal
    33  agent  and data system for claiming payment for evaluations and services
    34  rendered under the early intervention program.
    35    [(b) The commissioner, in consultation with the director of budget and
    36  the superintendent of financial services, shall  promulgate  regulations
    37  providing  public reimbursement for deductibles and copayments which are
    38  imposed under an insurance policy or health benefit plan to  the  extent
    39  that  such  deductibles  and  copayments  are applicable to early inter-
    40  vention services.
    41    (c) Payments made for early intervention services under  an  insurance
    42  policy  or  health  benefit plan, including payments made by the medical
    43  assistance program or other governmental third party  payor,  which  are
    44  provided  as  part  of  an  IFSP pursuant to section twenty-five hundred
    45  forty-five of this title shall not be applied by  the  insurer  or  plan
    46  administrator against any maximum lifetime or annual limits specified in
    47  the  policy  or  health benefits plan, pursuant to section eleven of the
    48  chapter of the laws of nineteen  hundred  ninety-two  which  added  this
    49  title.
    50    (d)]  (c)  A  municipality,  or  its designee, and a provider shall be
    51  subrogated, to the extent of the expenditures by  such  municipality  or
    52  for  early intervention services furnished to persons eligible for bene-
    53  fits under this title, to any rights such person may have or be entitled
    54  to from [third party reimbursement] the medical assistance program.  The
    55  provider shall submit notice to the insurer or plan administrator of his
    56  or her exercise of such right of subrogation upon the provider's assign-

        A. 356                              4
 
     1  ment as the early intervention service provider for the child. The right
     2  of  subrogation  does not attach to benefits paid or provided [under any
     3  health insurance policy or health benefits plan]  prior  to  receipt  of
     4  written  notice of the exercise of subrogation rights [by the insurer or
     5  plan administrator providing such benefits]. Notwithstanding any  incon-
     6  sistent provision of this title, except as provided for herein, no third
     7  party  payor other than the medical assistance program shall be required
     8  to reimburse for early intervention services provided under this title.
     9    § 8. Subdivision 3 of  section  2543  of  the  public  health  law  is
    10  REPEALED.
    11    § 9. Section 3235-a of the insurance law is REPEALED.
    12    §  10.  Subparagraph  (F) of paragraph 25 of subsection (i) of section
    13  3216 of the insurance law is REPEALED.
    14    § 11. Subparagraph (F) of paragraph 17 of subsection  (1)  of  section
    15  3221 of the insurance law is REPEALED.
    16    §  12. Paragraph 6 of subsection (ee) of section 4303 of the insurance
    17  law is REPEALED.
    18    § 13. This act shall take effect January 1, 2020;  provided,  however,
    19  that  the  amendments to section 2807-s of the public health law made by
    20  sections two and three of this act shall not affect  the  expiration  of
    21  such  section  and  shall be deemed to expire therewith. Effective imme-
    22  diately, the addition, amendment and/or repeal of any rule or regulation
    23  necessary for the implementation of this act on its effective  date  are
    24  authorized to be made and completed by the commissioner of health, on or
    25  before such effective date.
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A00356 LFIN:

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A00356 Chamber Video/Transcript:

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