S03338 Summary:

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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S03338 Actions:

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S03338 Committee Votes:

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S03338 Floor Votes:

There are no votes for this bill in this legislative session.
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S03338 Text:

                STATE OF NEW YORK
                               2019-2020 Regular Sessions
                    IN SENATE
                                    February 5, 2019
        Introduced  by  Sens. CARLUCCI, FUNKE -- 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  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-
    22  tionate  share  of the total approved statewide dollars not reimbursable
    23  by the medical assistance program paid  to  providers  of  early  inter-
    24  vention  services  by  the  state and municipalities on account of early
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        S. 3338                             2
     1  intervention services in the last complete state fiscal year  for  which
     2  such data is available.
     3    §  2.  Subdivision  6  of  section  2807-s of the public health law is
     4  amended by adding two new paragraphs (g) and (h) to read as follows:
     5    (g) A further gross statewide amount for the  state  fiscal  year  two
     6  thousand  twenty  and each state fiscal year thereafter shall be fifteen
     7  million dollars.
     8    (h) The amount specified in paragraph (g) of this subdivision shall be
     9  allocated under section twenty-eight hundred  seven-o  of  this  article
    10  among the municipalities and the state of New York based on each munici-
    11  pality's  share  and  the  state's  share  of early intervention program
    12  expenditures not reimbursable by the medical assistance program for  the
    13  latest twelve month period for which such data is available.
    14    §  3.  Subdivision  7  of  section  2807-s of the public health law is
    15  amended by adding a new paragraph (d) to read as follows:
    16    (d) funds shall be added to the funds collected  by  the  commissioner
    17  for distribution in accordance with section twenty-eight hundred seven-o
    18  of  this  article,  in the following amount: fifteen million dollars for
    19  the period beginning April first, two thousand  twenty,  and  continuing
    20  each state fiscal year thereafter.
    21    §  4.  Subdivision  1  of  section  2557  of the public health law, as
    22  amended by section 4 of part C of chapter 1 of  the  laws  of  2002,  is
    23  amended to read as follows:
    24    1. The approved costs for an eligible child who receives an evaluation
    25  and early intervention services pursuant to this title shall be a charge
    26  upon  the  municipality wherein the eligible child resides or, where the
    27  services are covered by the medical assistance program, upon the  social
    28  services  district of fiscal responsibility with respect to those eligi-
    29  ble children who are also eligible for medical assistance. All  approved
    30  costs  shall be paid in the first instance and at least quarterly by the
    31  appropriate governing body or officer of the municipality upon  vouchers
    32  presented  and  audited  in  the same manner as the case of other claims
    33  against the municipality. Notwithstanding the  insurance  law  or  regu-
    34  lations thereunder relating to the permissible exclusion of payments for
    35  services under governmental programs, no such exclusion shall apply with
    36  respect  to  payments  made  pursuant to this title. Notwithstanding the
    37  insurance law or any other law or agreement to  the  contrary,  benefits
    38  under this title shall be considered secondary to [any plan of insurance
    39  or  state government benefit] the medical assistance program under which
    40  an eligible child may have coverage.  [Nothing  in  this  section  shall
    41  increase  or enhance coverages provided for within an insurance contract
    42  subject to the provisions of this title.]
    43    § 5. Subdivision 2 of section  2557  of  the  public  health  law,  as
    44  amended  by  section 9-a of part A of chapter 56 of the laws of 2012, is
    45  amended to read as follows:
    46    2. The department shall reimburse the approved costs paid by a munici-
    47  pality for the purposes of this title, other than those reimbursable  by
    48  the  medical assistance program [or by third party payors], in an amount
    49  of fifty percent of the amount expended in accordance with the rules and
    50  regulations  of  the  commissioner;  provided,  however,  that  in   the
    51  discretion  of  the  department and with the approval of the director of
    52  the division of the budget, the department may reimburse  municipalities
    53  in  an  amount  greater  than fifty percent of the amount expended. Such
    54  state reimbursement to the municipality shall not be paid prior to April
    55  first of the year in which the approved costs are paid  by  the  munici-
    56  pality,  provided, however that, subject to the approval of the director

        S. 3338                             3
     1  of the budget, the department may pay such state  aid  reimbursement  to
     2  the municipality prior to such date.
     3    §  6. The section heading of section 2559 of the public health law, as
     4  added by chapter 428 of the laws of 1992, is amended to read as follows:
     5    [Third  party  insurance  and  medical]  Medical  assistance   program
     6  payments.
     7    §  7. Subdivision 3 of section 2559 of the public health law, as added
     8  by chapter 428 of the laws of 1992,  paragraphs  (a),  (c)  and  (d)  as
     9  amended  by  section  11 of part A of chapter 56 of the laws of 2012 and
    10  paragraph (b) as further amended by section 104 of part A of chapter  62
    11  of the laws of 2011, is amended to read as follows:
    12    3.  (a)  [Providers  of  evaluations  and early intervention services,
    13  hereinafter collectively referred to in this subdivision  as  "provider"
    14  or  "providers",  shall in the first instance and where applicable, seek
    15  payment from all third  party  payors  including  governmental  agencies
    16  prior  to  claiming  payment  from  a given municipality for evaluations
    17  conducted under the program and for services rendered to eligible  chil-
    18  dren, provided that, the obligation to seek payment shall not apply to a
    19  payment  from  a  third  party payor who is not prohibited from applying
    20  such payment, and will apply such payment,  to  an  annual  or  lifetime
    21  limit specified in the insured's policy.
    22    (i)  Parents  shall  provide  the municipality and service coordinator
    23  information on any insurance policy, plan or  contract  under  which  an
    24  eligible child has coverage.
    25    (ii)] Parents shall provide the municipality and the service coordina-
    26  tor  with  a written referral from a primary care provider as documenta-
    27  tion, for eligible children, of the medical necessity  of  early  inter-
    28  vention services.
    29    [(iii)  providers] (b) Providers shall utilize the department's fiscal
    30  agent and data system for claiming payment for evaluations and  services
    31  rendered under the early intervention program.
    32    [(b) The commissioner, in consultation with the director of budget and
    33  the  superintendent  of financial services, shall promulgate regulations
    34  providing public reimbursement for deductibles and copayments which  are
    35  imposed  under  an insurance policy or health benefit plan to the extent
    36  that such deductibles and copayments  are  applicable  to  early  inter-
    37  vention services.
    38    (c)  Payments  made for early intervention services under an insurance
    39  policy or health benefit plan, including payments made  by  the  medical
    40  assistance  program  or  other governmental third party payor, which are
    41  provided as part of an IFSP  pursuant  to  section  twenty-five  hundred
    42  forty-five  of  this  title  shall not be applied by the insurer or plan
    43  administrator against any maximum lifetime or annual limits specified in
    44  the policy or health benefits plan, pursuant to section  eleven  of  the
    45  chapter  of  the  laws  of  nineteen hundred ninety-two which added this
    46  title.
    47    (d)] (c) A municipality, or its designee,  and  a  provider  shall  be
    48  subrogated,  to  the  extent of the expenditures by such municipality or
    49  for early intervention services furnished to persons eligible for  bene-
    50  fits under this title, to any rights such person may have or be entitled
    51  to  from [third party reimbursement] the medical assistance program. The
    52  provider shall submit notice to the insurer or plan administrator of his
    53  or her exercise of such right of subrogation upon the provider's assign-
    54  ment as the early intervention service provider for the child. The right
    55  of subrogation does not attach to benefits paid or provided  [under  any
    56  health  insurance  policy  or  health benefits plan] prior to receipt of

        S. 3338                             4
     1  written notice of the exercise of subrogation rights [by the insurer  or
     2  plan  administrator providing such benefits]. Notwithstanding any incon-
     3  sistent provision of this title, except as provided for herein, no third
     4  party  payor other than the medical assistance program shall be required
     5  to reimburse for early intervention services provided under this title.
     6    § 8. Subdivision 3 of  section  2543  of  the  public  health  law  is
     7  REPEALED.
     8    § 9. Section 3235-a of the insurance law is REPEALED.
     9    §  10.  Subparagraph  (F) of paragraph 25 of subsection (i) of section
    10  3216 of the insurance law is REPEALED.
    11    § 11. Subparagraph (F) of paragraph 17 of subsection  (1)  of  section
    12  3221 of the insurance law is REPEALED.
    13    §  12. Paragraph 6 of subsection (ee) of section 4303 of the insurance
    14  law is REPEALED.
    15    § 13. This act shall take effect January 1, 2020;  provided,  however,
    16  that  the  amendments to section 2807-s of the public health law made by
    17  sections two and three of this act shall not affect  the  expiration  of
    18  such  section  and  shall be deemed to expire therewith. Effective imme-
    19  diately, the addition, amendment and/or repeal of any rule or regulation
    20  necessary for the implementation of this act on its effective  date  are
    21  authorized to be made and completed by the commissioner of health, on or
    22  before such effective date.
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