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A05339 Summary:

COSPNSRGottfried, Cahill, Cook, Galef, Gunther, Magnarelli, Lupardo, Dinowitz, Benedetto, Abinanti, Barron, Meeks, Jensen, Sillitti, Kelles, Lunsford, Griffin, Englebright, Walsh
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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A05339 Text:

                STATE OF NEW YORK
                               2021-2022 Regular Sessions
                   IN ASSEMBLY
                                    February 12, 2021
        Introduced  by M. of A. PAULIN, GOTTFRIED, CAHILL, COOK, GALEF, GUNTHER,
          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-
    22  tionate share of the total approved statewide dollars  not  reimbursable
    23  by  the  medical  assistance  program  paid to providers of early inter-
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 5339                             2
     1  vention services by the state and municipalities  on  account  of  early
     2  intervention  services  in the last complete state fiscal year for which
     3  such data is available.
     4    §  2.  Subdivision  6  of  section  2807-s of the public health law is
     5  amended by adding two new paragraphs (g) and (h) to read as follows:
     6    (g) A further gross statewide amount for the  state  fiscal  year  two
     7  thousand twenty-two and each state fiscal year thereafter shall be forty
     8  million dollars.
     9    (h) The amount specified in paragraph (g) of this subdivision shall be
    10  allocated  under  section  twenty-eight  hundred seven-o of this article
    11  among the municipalities and the state of New York based on each munici-
    12  pality's share and the  state's  share  of  early  intervention  program
    13  expenditures  not reimbursable by the medical assistance program for the
    14  latest twelve month period for which such data is available.
    15    § 3. Subdivision 7 of section 2807-s  of  the  public  health  law  is
    16  amended by adding a new paragraph (d) to read as follows:
    17    (d)  funds  shall  be added to the funds collected by the commissioner
    18  for distribution in accordance with section twenty-eight hundred seven-o
    19  of this article, in the following amount: forty million dollars for  the
    20  period  beginning  April  first, two thousand twenty-two, and continuing
    21  each state fiscal year thereafter.
    22    § 4. Subdivision 1 of section  2557  of  the  public  health  law,  as
    23  amended  by  section  4  of  part C of chapter 1 of the laws of 2002, is
    24  amended to read as follows:
    25    1. The approved costs for an eligible child who receives an evaluation
    26  and early intervention services pursuant to this title shall be a charge
    27  upon the municipality wherein the eligible child resides or,  where  the
    28  services  are covered by the medical assistance program, upon the social
    29  services district of fiscal responsibility with respect to those  eligi-
    30  ble  children who are also eligible for medical assistance. All approved
    31  costs shall be paid in the first instance and at least quarterly by  the
    32  appropriate  governing body or officer of the municipality upon vouchers
    33  presented and audited in the same manner as the  case  of  other  claims
    34  against  the  municipality.  Notwithstanding  the insurance law or regu-
    35  lations thereunder relating to the permissible exclusion of payments for
    36  services under governmental programs, no such exclusion shall apply with
    37  respect to payments made pursuant to  this  title.  Notwithstanding  the
    38  insurance  law  or  any other law or agreement to the contrary, benefits
    39  under this title shall be considered secondary to [any plan of insurance
    40  or state government benefit] the medical assistance program under  which
    41  an  eligible  child  may  have  coverage. [Nothing in this section shall
    42  increase or enhance coverages provided for within an insurance  contract
    43  subject to the provisions of this title.]
    44    §  5.  Subdivision  2  of  section  2557  of the public health law, as
    45  amended by section 9-a of part A of chapter 56 of the laws of  2012,  is
    46  amended to read as follows:
    47    2. The department shall reimburse the approved costs paid by a munici-
    48  pality  for the purposes of this title, other than those reimbursable by
    49  the medical assistance program [or by third party payors], in an  amount
    50  of fifty percent of the amount expended in accordance with the rules and
    51  regulations   of  the  commissioner;  provided,  however,  that  in  the
    52  discretion of the department and with the approval of  the  director  of
    53  the  division of the budget, the department may reimburse municipalities
    54  in an amount greater than fifty percent of  the  amount  expended.  Such
    55  state reimbursement to the municipality shall not be paid prior to April
    56  first  of  the  year in which the approved costs are paid by the munici-

        A. 5339                             3
     1  pality, provided, however that, subject to the approval of the  director
     2  of  the  budget,  the department may pay such state aid reimbursement to
     3  the municipality prior to such date.
     4    §  6. The section heading of section 2559 of the public health law, as
     5  added by chapter 428 of the laws of 1992, is amended to read as follows:
     6    [Third  party  insurance  and  medical]  Medical  assistance   program
     7  payments.
     8    §  7. Subdivision 3 of section 2559 of the public health law, as added
     9  by chapter 428 of the laws of 1992,  paragraphs  (a),  (c)  and  (d)  as
    10  amended  by  section  11 of part A of chapter 56 of the laws of 2012 and
    11  paragraph (b) as further amended by section 104 of part A of chapter  62
    12  of the laws of 2011, is amended to read as follows:
    13    3.  (a)  [Providers  of  evaluations  and early intervention services,
    14  hereinafter collectively referred to in this subdivision  as  "provider"
    15  or  "providers",  shall in the first instance and where applicable, seek
    16  payment from all third  party  payors  including  governmental  agencies
    17  prior  to  claiming  payment  from  a given municipality for evaluations
    18  conducted under the program and for services rendered to eligible  chil-
    19  dren, provided that, the obligation to seek payment shall not apply to a
    20  payment  from  a  third  party payor who is not prohibited from applying
    21  such payment, and will apply such payment,  to  an  annual  or  lifetime
    22  limit specified in the insured's policy.
    23    (i)  Parents  shall  provide  the municipality and service coordinator
    24  information on any insurance policy, plan or  contract  under  which  an
    25  eligible child has coverage.
    26    (ii)] Parents shall provide the municipality and the service coordina-
    27  tor  with  a written referral from a primary care provider as documenta-
    28  tion, for eligible children, of the medical necessity  of  early  inter-
    29  vention services.
    30    [(iii)  providers] (b) Providers shall utilize the department's fiscal
    31  agent and data system for claiming payment for evaluations and  services
    32  rendered under the early intervention program.
    33    [(b) The commissioner, in consultation with the director of budget and
    34  the  superintendent  of financial services, shall promulgate regulations
    35  providing public reimbursement for deductibles and copayments which  are
    36  imposed  under  an insurance policy or health benefit plan to the extent
    37  that such deductibles and copayments  are  applicable  to  early  inter-
    38  vention services.
    39    (c)  Payments  made for early intervention services under an insurance
    40  policy or health benefit plan, including payments made  by  the  medical
    41  assistance  program  or  other governmental third party payor, which are
    42  provided as part of an IFSP  pursuant  to  section  twenty-five  hundred
    43  forty-five  of  this  title  shall not be applied by the insurer or plan
    44  administrator against any maximum lifetime or annual limits specified in
    45  the policy or health benefits plan, pursuant to section  eleven  of  the
    46  chapter  of  the  laws  of  nineteen hundred ninety-two which added this
    47  title.
    48    (d)] (c) A municipality, or its designee,  and  a  provider  shall  be
    49  subrogated,  to  the  extent of the expenditures by such municipality or
    50  for early intervention services furnished to persons eligible for  bene-
    51  fits under this title, to any rights such person may have or be entitled
    52  to  from [third party reimbursement] the medical assistance program. The
    53  provider shall submit notice to the insurer or plan administrator of his
    54  or her exercise of such right of subrogation upon the provider's assign-
    55  ment as the early intervention service provider for the child. The right
    56  of subrogation does not attach to benefits paid or provided  [under  any

        A. 5339                             4

     1  health  insurance  policy  or  health benefits plan] prior to receipt of
     2  written notice of the exercise of subrogation rights [by the insurer  or
     3  plan  administrator providing such benefits]. Notwithstanding any incon-
     4  sistent provision of this title, except as provided for herein, no third
     5  party  payor other than the medical assistance program shall be required
     6  to reimburse for early intervention services provided under this title.
     7    § 8. Subdivision 3 of  section  2543  of  the  public  health  law  is
     8  REPEALED.
     9    § 9. Section 3235-a of the insurance law is REPEALED.
    10    §  10.  Subparagraph  (F) of paragraph 25 of subsection (i) of section
    11  3216 of the insurance law is REPEALED.
    12    § 11. Subparagraph (F) of paragraph 17 of subsection  (1)  of  section
    13  3221 of the insurance law is REPEALED.
    14    §  12. Paragraph 6 of subsection (ee) of section 4303 of the insurance
    15  law is REPEALED.
    16    § 13. This act shall take effect January 1, 2022;  provided,  however,
    17  that  the  amendments to section 2807-s of the public health law made by
    18  sections two and three of this act shall not affect  the  expiration  of
    19  such  section  and  shall be deemed to expire therewith. Effective imme-
    20  diately, the addition, amendment and/or repeal of any rule or regulation
    21  necessary for the implementation of this act on its effective  date  are
    22  authorized to be made and completed by the commissioner of health, on or
    23  before such effective date.
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