STATE OF NEW YORK
________________________________________________________________________
1727--A
2017-2018 Regular Sessions
IN SENATE
January 10, 2017
___________
Introduced by Sen. CARLUCCI -- read twice and ordered printed, and when
printed to be committed to the Committee on Health -- recommitted to
the Committee on Health in accordance with Senate Rule 6, sec. 8 --
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; 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.
LBD01073-05-8
S. 1727--A 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 nineteen 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 nineteen, 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
S. 1727--A 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-
S. 1727--A 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, 2019; 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.
