Albany, New York – Assemblymember Amy Paulin (D-Scarsdale) announces that the New York State Legislature has passed her bill, A5339/S5560A, with bipartisan support, which streamlines the funding of Early Intervention services.
The bill raises $40 million by expanding the “Covered Lives” assessment fee on health insurance companies, improving a funding system in place since 2013 which has caused extensive delays in reimbursements to providers, leading many Early Intervention service providers to shut their doors and causing a lack of available providers throughout the state. This new funding mechanism will ensure that providers receive reimbursement payments directly from the state via a fund paid for in advance by the health insurance industry.
“It is critical that children with developmental delays and special needs receive the early intervention services they need, as soon as possible,” said Assemblymember Amy Paulin. “Streamlining the reimbursement process will help these families. At the same time, it will provide relief to property tax payers by requiring insurance companies to pay their fair share and reducing costs to the counties and State.”
Under current law, when an Early Intervention Services provider renders services, they must bill the insurance company first. Typically, insurance companies reject over 85% of claims, which means providers do not get paid. In New York State, Early Intervention Services are guaranteed for children under the age of three by state law, and so any claims unpaid by insurance companies are ultimately paid by New York State, which charges local counties for the cost of the services. This process can take weeks, months, or even years to sort out, and often means that providers do not receive reimbursement in a timely manner. This also results in counties and municipalities paying for tens of millions of dollars in services that is ultimately paid for by the local taxpayer.
The bill uses the “Covered Lives” funding mechanism which taxes health Insurance companies to direct funds for specific health care purposes. This bill creates a $40 million funding stream specifically for Early Intervention services, and alters the way that providers will be reimbursed. Instead of sending claims to insurance companies, the bill for Early Intervention Services would be sent directly to the State for payment out of this fund. This new fund will shift the cost of these services from local municipalities to health insurance companies and save counties approximately $20 million while saving New York State approximately $6.5 million.
“Early intervention services provide life-changing help to children under three years old, but far too often parents face lengthy delays in getting these critical services for their kids,” said Senator Elijah Reichlin-Melnick. “These delays are caused by the current dysfunctional system of paying providers, and we have a responsibility to solve it. Our bill will save counties around the state $20 million while creating a reliable fund for early intervention service providers, funded by the health insurance industry. This is a critical step in ensuring that children receive the care that they need as soon as possible.”
Dr. Indu Gupta, NYSACHO President, said “The New York State Association of County Health Officials (NYSACHO) appreciates the hard work of Assemblymember Amy Paulin and Senator Reichlin-Melnick in advancing this important legislation and thanks the State Legislature for passing A5339/S5560A.The bill ensures that commercial health insurers contribute their fair share to support the Early Intervention (EI) program. This will assure good stewardship of state and local tax dollars and most importantly, allow EI professionals to focus more on the vital services they provide to children and families with special needs to achieve the best health outcomes possible.”
Stephen J. Acquario, Executive Director of the New York State Association of Counties said, “Early intervention services are a lifeline for children with special needs and their families, but too many private health insurers refuse to pay their fair share for these services, passing the buck on to taxpayers. This legislation is a massive step forward in reforming and strengthening the Early Intervention program so that more children can get the help they need, when they need it. Counties commend Assemblymembers Paulin and Gottfried, and Senator Reichlin-Melnick for their leadership and commitment to ensuring children with special needs have access to the services that allow them to reach their fullest potential.”
Mike Alvaro, Executive Director of CP of NYS, said “When a group of determined parents formed Cerebral Palsy Associations of NYS 75 years ago, Early Intervention services were exactly the type of supports they were looking for. These services identify and evaluate developmental delays in infants and toddlers, and provide appropriate therapy and supports at a crucial point in their lives. Unfortunately, inadequate reimbursement and an excessive administrative burden have led to a critical shortage of beneficial Early Intervention services. CP of NYS and its 24 Affiliates statewide strongly support and applaud Assemblymembers Paulin and Gottfried, and Senator Reichlin-Melnick’s, proposal to establish a new funding mechanism to support life-changing Early Intervention services.”
Brigit Hurley, Senior Director of Advocacy and Program, The Children’s Agenda “Kid’s Can’t Wait” program, said “Children and families struggling to get the Early Intervention services they urgently need will benefit from this legislation. We celebrate the State Legislature’s passage of A5339/S5560A because, with more resources and fewer administrative barriers, the Early Intervention program can address inequitable access to services and a severe provider shortage that has forced children and families to wait too long for federally-guaranteed evaluations and therapies that have the potential to change the trajectory of a child’s life. If signed by the Governor, we look forward to working with state leaders to ensure this legislation results in significant investments in the EI system to help increase supports and services for children and families. We are grateful to Senator Reichlin-Melnick for his leadership in bringing the bill through the Senate toward its passage and for the leadership of Assemblymembers Paulin and Gottfried in the Assembly.”
Winifred Schiff, Associate Executive Director for Legislative Affairs at InterAgency Council of Developmental Disabilities Agencies, said “Finally, some good news for the Early Intervention Program that has been shown to significantly improve the lives and future prognosis of babies and toddlers with developmental delays! IAC applauds Assemblymember Paulin and Senator Reichlin-Melnick for their work in ensuring a brighter future for children with developmental delays and their families. We are grateful!”
This bill is sponsored in the New York State Senate by Senator Elijah Reichlin-Melnick.