A08316 Summary:

BILL NOA08316B
 
SAME ASNo same as
 
SPONSORGottfried (MS)
 
COSPNSRCahill, Hevesi, Abinanti, Braunstein, Bronson, Buchwald, Fahy, Jacobs, Jaffee, Lupardo, Markey, Miller, Millman, O'Donnell, Otis, Paulin, Raia, Roberts, Schimel, Sepulveda, Skartados, Skoufis, Steck, Stirpe, Sweeney, Thiele, Weisenberg, Zebrowski, Scarborough, Rosenthal, Cook, Gunther, Lifton, Benedetto, Weprin, Rozic, Galef, Clark, Titone, Robinson, Russell, Cusick, Saladino, Lavine, Colton, Barrett, Brook-Krasny, McDonald, Brindisi, Goodell, Magnarelli, Dinowitz
 
MLTSPNSRArroyo, Brennan, Crouch, Duprey, Heastie, Kearns, Lupinacci, Mayer, McDonough, Ra, Rodriguez, Simanowitz, Walter, Wright
 
Amd SS2557 & 2559, Pub Health L; amd S3235-a & 3224-a, Ins L; amd Part A S19, Chap 60 of 2014
 
Provides for the payment by the state of the costs of an evaluation and early intervention services to eligible children.
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A08316 Actions:

BILL NOA08316B
 
12/18/2013referred to health
01/08/2014referred to health
01/14/2014reported referred to ways and means
06/09/2014amend (t) and recommit to ways and means
06/09/2014print number 8316a
06/12/2014amend and recommit to ways and means
06/12/2014print number 8316b
06/17/2014held for consideration in ways and means
06/18/2014reported referred to rules
06/18/2014reported
06/19/2014rules report cal.455
06/19/2014ordered to third reading rules cal.455
06/19/2014passed assembly
06/19/2014delivered to senate
06/19/2014REFERRED TO RULES
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A08316 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A8316B
 
SPONSOR: Gottfried (MS)
  TITLE OF BILL: An act to amend the public health law, the insurance law and chapter 60 of the laws of 2014 amending the public health law relating to payments submitted by early intervention providers to certain third party payors, in relation to the financial responsibility for and reimbursement of payment for early intervention services by the state   PURPOSE OR GENERAL IDEA OF BILL: To clarify the role of the state's early intervention (EI) fiscal agent and ensure timely payment to providers so that infants and toddlers in New York State have timely access to El services.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 of the bill amends subdivision 1 of Section 2557 of the Public Health Law to provide that El providers must be paid in full at the State El rate by the State or the State Fiscal Agent (SFA) designated by the New York State Department of Health (NYS DOH) at least quarterly for claims other than Medicaid claims. Section 2 of the bill adds a new subparagraph (i) to paragraph (a) of subdivision (5) of Section 2557 of the Public Health to enumerate the duties of the SFA including collaborating with EI providers to process claims, facilitating the submission of subrogation notices to third party payors, and issuing payments to providers. Section 3 of the bill amends paragraph (a) of subdivision 3 of Section 2559 of the Public Health Law by adding a new subparagraph (iv) to require the SFA to conduct a reconciliation of their third party reimbursement at least quarterly. Section 4 of the bill adds a new subdivision 3-a to Section 2559 of the Public Health Law to authorize an EI provider to seek payment from the SFA 90 days after initial-submission of a claim to a commercial health insurance company that is not regulated by the State of New York if such insurer has not made payment of the claim in whole or in part or rendered a determination that it is not obligated to pay the claim. Section 5 of the bill amends subsection c of Section 3235-a of the Insurance Law to require insurance companies to make payments for EI services to the provider who submits the claim, regardless of whether the provider is in the insurer's network. In addition, it requires remittance paperwork be transmitted to the SFA. Section 6 of the bill amends paragraph (2) of subsection d of Section 3224-a of the Insurance Law to define El providers as providers for the purpose of the existing Prompt Pay Law. Section 7 amends section 19 of part A of chapter 60 of the laws of 2014, which authorized the Department to pay providers for outstanding claims filed between April 1, 2013 and June 30, 2013 using $3.9 million allo- cated in the FY14 budget. Section 7 allows the Department to use any money remaining from this pool to pay additional outstanding claims dated after June 30, 2013. Section 8 provides that the act shall take effect on January 1, 2015, except for section 7 which shall take effect immediately, and shall apply to claims other than those for the medical assistance program submitted to third party payers after June 30, 2013.   JUSTIFICATION: The 2012-13 State Budget (Section 11 of Part A of Chapter 56 of the Laws of 2012) transferred the responsibility for EI billing from county government to an SFA under contract with NYS DOH, effective April 1, 2013 in order to achieve a more efficient and effec- tive process with the expectation that a larger proportion of EI claims would be paid by third party insurance. This bill makes clarifying amendments to ensure that the original intent of making a more efficient and effective process is in fact realized. Under the new system, providers are caught between patients, insurers and the SFA awaiting decisions and information that are often out of their control. As a result they are experiencing devastating payment delays and administrative burdens which have made the El program fiscal- ly unsustainable for some providers. Access to services for infants and children who rely on this program for critical therapies may be serious- ly jeopardized as providers leave the program. This was not the intended consequence of the creation of a fiscal agent in the 2013-14 State Budg- et.   PRIOR LEGISLATIVE HISTORY: None   FISCAL IMPLICATIONS: None. Delays and lack of access to preventative services will actually increase long term costs for special education services for school age children.   EFFECTIVE DATE: January 1, 2015, except for section 7 which shall take effect immediately.
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A08316 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         8316--B
 
                               2013-2014 Regular Sessions
 
                   IN ASSEMBLY
 
                                    December 18, 2013
                                       ___________
 
        Introduced  by M. of A. GOTTFRIED, CAHILL, HEVESI, ABINANTI, BRAUNSTEIN,
          BRONSON, BUCHWALD, FAHY,  JACOBS,  JAFFEE,  LUPARDO,  MARKEY,  MILLER,
          MILLMAN,  O'DONNELL,  OTIS,  PAULIN,  RAIA,  ROBERTS,  ROSA,  SCHIMEL,
          SEPULVEDA, SKARTADOS, SKOUFIS, STECK, STIRPE, SWEENEY, THIELE, WEISEN-
          BERG, ZEBROWSKI, SCARBOROUGH, ROSENTHAL, COOK, GUNTHER, LIFTON,  BENE-

          DETTO, WEPRIN, ROZIC, GALEF, CLARK, TITONE, ROBINSON, RUSSELL, CUSICK,
          SALADINO,  LAVINE,  COLTON, BARRETT, BROOK-KRASNY, McDONALD, BRINDISI,
          GOODELL, MAGNARELLI -- Multi-Sponsored by -- M. of A. ARROYO, BRENNAN,
          CROUCH, DUPREY, HEASTIE,  KEARNS,  LUPINACCI,  MAYER,  McDONOUGH,  RA,
          RODRIGUEZ, SIMANOWITZ, WALTER, WRIGHT -- read once and referred to the
          Committee  on  Health  --  recommitted  to  the Committee on Health in
          accordance with Assembly Rule 3, sec. 2 -- reported  and  referred  to
          the Committee on Ways and Means -- committee discharged, bill amended,
          ordered  reprinted  as  amended  and  recommitted to said committee --
          again reported from said committee with amendments, ordered  reprinted
          as amended and recommitted to said committee
 
        AN  ACT to amend the public health law, the insurance law and chapter 60

          of the laws of  2014  amending  the  public  health  law  relating  to
          payments  submitted  by  early intervention providers to certain third
          party payors, in relation to  the  financial  responsibility  for  and
          reimbursement of payment for early intervention services by the state
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Subdivision 1 of section 2557 of the public health law,  as
     2  amended  by  section  4  of  part C of chapter 1 of the laws of 2002, is
     3  amended to read as follows:
     4    1. The approved costs for an eligible child who receives an evaluation
     5  and early intervention services pursuant to this title shall be a charge
     6  upon the municipality wherein the eligible child resides or,  where  the
     7  services  are covered by the medical assistance program, upon the social

     8  services district of fiscal responsibility with respect to those  eligi-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13146-11-4

        A. 8316--B                          2
 
     1  ble  children who are also eligible for medical assistance. All approved
     2  costs shall be paid in full at the  state  approved  early  intervention
     3  rate  in  the  first instance and at least quarterly [by the appropriate
     4  governing  body  or  officer of the municipality upon vouchers presented
     5  and audited in the same manner as the case of other claims  against  the

     6  municipality]  by  the state or its designated fiscal agent on behalf of
     7  the municipality for claims other than claims  for  medical  assistance.
     8  Notwithstanding  the insurance law or regulations thereunder relating to
     9  the permissible exclusion of payments for  services  under  governmental
    10  programs,  no  such  exclusion shall apply with respect to payments made
    11  pursuant to this title. Notwithstanding the insurance law or  any  other
    12  law  or  agreement  to  the contrary, benefits under this title shall be
    13  considered secondary to any plan of insurance or state government  bene-
    14  fit  program under which an eligible child may have coverage. Nothing in
    15  this section shall increase or enhance coverages provided for within  an
    16  insurance contract subject to the provisions of this title.

    17    §  2.    The  opening  paragraph  of paragraph (a) of subdivision 5 of
    18  section 2557 of the public health law is designated subparagraph (i) and
    19  a new subparagraph (ii) is added to read as follows:
    20    (ii) The fiscal agent's duties shall include, but not be  limited  to,
    21  the following:
    22    (1)  Collaborating  with  providers to process payable claims with all
    23  third party payors, including but not limited to, overseeing and facili-
    24  tating the resubmission of claims  when  further  information  has  been
    25  requested by such third party payor;
    26    (2) Facilitating the submission of subrogation notices by the provider
    27  to third party payors;
    28    (3)  Processing  and  transmitting  claims  from the department's data

    29  system for services that may be covered by a third party payor; and
    30    (4) Issuing payment to providers for services not covered by  a  third
    31  party payor in accordance with this title.
    32    §  3.  Paragraph  (a)  of  subdivision 3 of section 2559 of the public
    33  health law is amended by adding a  new  subparagraph  (iv)  to  read  as
    34  follows:
    35    (iv)  The  fiscal agent shall, at least quarterly, conduct a reconcil-
    36  iation of third party reimbursement pursuant  to  this  subdivision  and
    37  provide  reimbursement  at  levels  in accordance with this title to the
    38  state and municipalities.
    39    § 4. Section 2559 of the public health law is amended by adding a  new
    40  subdivision 3-a to read as follows:
    41    3-a.  Commencing  on and after the effective date of this subdivision,

    42  only for those third party payors who are not subject to the  provisions
    43  of  section  three  thousand  two hundred thirty-five-a of the insurance
    44  law, if a parent provides consent to  access  coverage  available  under
    45  such  third party payor and the third party payor has not, within ninety
    46  days of the initial submission of said claim, made payment of the  claim
    47  in whole or in part or rendered a determination that it is not obligated
    48  to  pay  the  claim, the provider shall be authorized to seek payment of
    49  such claim  from  the  municipality,  through  the  fiscal  agent  under
    50  contract with the department. If such third party payor makes payment of
    51  the  claim after the provider has received payment from the municipality

    52  through the fiscal agent, the third party payment  shall  be  reconciled
    53  against future payments due to the provider from the municipality.
    54    §  5.    Subsection  (c)  of  section  3235-a of the insurance law, as
    55  amended by section 17 of part A of chapter 56 of the laws  of  2012,  is
    56  amended to read as follows:

        A. 8316--B                          3
 
     1    (c)  Any  right  of  subrogation  to  benefits which a municipality or
     2  provider is entitled in accordance with  paragraph  (d)  of  subdivision
     3  three of section twenty-five hundred fifty-nine of the public health law
     4  shall  be  valid  and  enforceable  to the extent benefits are available
     5  under any accident and health insurance policy. The right of subrogation
     6  does  not  attach to insurance benefits paid or provided under any acci-

     7  dent and health insurance policy prior to  receipt  by  the  insurer  of
     8  written  notice from the municipality or provider, as applicable.  If an
     9  insurer makes payment in whole or in  part  for  a  claim  or  bill  for
    10  services  rendered  under  the early intervention program established in
    11  title two-A of article  twenty-five  of  the  public  health  law,  such
    12  payment shall be made to the provider who submitted the claim and not to
    13  the  covered person regardless of whether such provider is in the insur-
    14  er's network, and a  remittance  advice  shall  be  transmitted  to  the
    15  department  of  health's  designated  fiscal  agent.  The  insurer shall
    16  provide the municipality and service coordinator with information on the

    17  extent of benefits available to the covered  person  under  such  policy
    18  within  fifteen  days  of  the  insurer's receipt of written request and
    19  notice authorizing such release. The service coordinator  shall  provide
    20  such  information to the rendering provider assigned to provide services
    21  to the child.
    22    § 6. Paragraph 2 of subsection (d) of section 3224-a of the  insurance
    23  law,  as  amended by section 57-b of part A of chapter 56 of the laws of
    24  2013, is amended to read as follows:
    25    (2) "health care provider" shall mean an entity licensed or  certified
    26  pursuant  to  article  twenty-eight,  thirty-six  or forty of the public
    27  health law, a facility licensed pursuant to article nineteen or  thirty-
    28  one  of  the  mental  hygiene law, a fiscal intermediary operating under
    29  section three hundred [sixty five-f] sixty-five-f of the social services

    30  law, an individual or agency approved by the department of health pursu-
    31  ant to title two-A of article twenty-five of the public  health  law,  a
    32  health  care  professional licensed, registered or certified pursuant to
    33  title eight of the education law, a dispenser or provider of  pharmaceu-
    34  tical  products,  services  or durable medical equipment, or a represen-
    35  tative designated by such entity or person.
    36    § 7. Section 19 of part A of chapter 60 of the laws of  2014  amending
    37  the  public  health  law  relating to payments submitted by early inter-
    38  vention providers to certain third party payors is amended  to  read  as
    39  follows:
    40    § 19. For claims for payment submitted by early intervention providers
    41  to  third  party  payors between the period April 1, 2013 until June 30,
    42  2013 in accordance with title 2-A of article 25  of  the  public  health

    43  law,  for  which the third party payor has not, on the effective date of
    44  this section, made payment of the claim in whole or in part or  rendered
    45  a  determination that it is not obligated to pay the claim, the provider
    46  shall be authorized to seek payment of such claim from the municipality,
    47  through the fiscal agent under contract with the department  of  health;
    48  provided,  however,  that  the  provider  shall  continue  to render any
    49  assistance  needed,  and  provide  any  information  and   documentation
    50  requested  by  the  third party payor to facilitate payment of the claim
    51  even if the provider has already received payment from the municipality.
    52  If such third party payor makes payment of the claim after the  provider
    53  has  received  payment  from  the  municipality, the third party payment
    54  shall be reconciled against future payments due the  provider  from  the

    55  municipality.  This  section  shall  only  apply  to claims submitted by
    56  approved early intervention providers to third party payors  during  the

        A. 8316--B                          4
 
     1  period  April 1, 2013 until June 30, 2013 for which no payment or deter-
     2  mination has been made, as specified in this section, on April 1,  2014.
     3  Provided,  however, in the event that funds appropriated for the purpose
     4  of  this section exceed the amounts necessary to pay state reimbursement
     5  to municipalities for such claims, the period set forth herein shall  be
     6  expanded,  as  determined  by  the  department  of health subject to the
     7  availability of funding, to include additional claims  submitted  on  or
     8  after  April  1,  2013  by  early  intervention providers to third party

     9  payors for which the third party payor has not, on the effective date of
    10  this section, made payment of the claim in whole or in part or  rendered
    11  a  determination  that  it is not obligated to pay such claim; provided,
    12  further that all other provisions of this section shall  apply  to  such
    13  claims  to  be  paid  by a municipality in accordance with this section.
    14  Payment shall be made on the forty-fifth day after this act  shall  take
    15  effect.  The  provisions  in subdivision 2 of section 2557 of the public
    16  health law that prohibit state reimbursement from being  paid  prior  to
    17  April  first  of  the  year  in which the approved costs are paid by the
    18  municipality shall not apply to the municipal payments made  under  this
    19  section.
    20    §  8. This act shall take effect immediately; except that sections one

    21  through six of this act shall take effect January  1,  2015,  and  shall
    22  apply  to  all claims for payment, other than claims for medical assist-
    23  ance, submitted by an early intervention provider to third party  payors
    24  after  June 30, 2013; provided, however, that the commissioner of health
    25  is authorized and  directed  to  promulgate  regulations  and  take  all
    26  actions  necessary  and  appropriate to implement the provisions of this
    27  act on its effective date.
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