senate Bill S4013C

Facilitates payment of claims by health insurers to municipalities for early intervention services

download pdf

Sponsor

Co-Sponsors

Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
view actions

actions

  • 14 / Mar / 2011
    • REFERRED TO INSURANCE
  • 10 / Jun / 2011
    • AMEND (T) AND RECOMMIT TO INSURANCE
  • 10 / Jun / 2011
    • PRINT NUMBER 4013A
  • 13 / Jun / 2011
    • AMEND AND RECOMMIT TO INSURANCE
  • 13 / Jun / 2011
    • PRINT NUMBER 4013B
  • 15 / Jun / 2011
    • AMEND AND RECOMMIT TO INSURANCE
  • 15 / Jun / 2011
    • PRINT NUMBER 4013C
  • 21 / Jun / 2011
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 21 / Jun / 2011
    • ORDERED TO THIRD READING CAL.1463
  • 21 / Jun / 2011
    • SUBSTITUTED BY A384B

Summary

Facilitates payment of claims by health insurers to municipalities for early intervention services.

do you support this bill?

Bill Details

See Assembly Version of this Bill:
A384B
Versions:
S4013
S4013A
S4013B
S4013C
Legislative Cycle:
2011-2012
Law Section:
Insurance Law
Laws Affected:
Amd §3235-a, Ins L; amd §2559, Pub Health L
Versions Introduced in Previous Legislative Cycles:
2011-2012: A384A
2009-2010: A3719, A3719
2007-2008: A4399, A4399

Sponsor Memo

BILL NUMBER:S4013C

TITLE OF BILL:
An act
to amend the insurance law and the public health law,
in relation to coverage of early
intervention services

PURPOSE OR GENERAL IDEA OF BILL:
To amend the insurance law to ensure recoupment from commercial
insurers for the cost of the Early Intervention program.

SUMMARY OF SPECIFIC PROVISIONS:
Section one amends Section 3235-a of the insurance law, as added by
section 3 of part C of chapter 1 of the laws of 2002, to prohibit
accident and health insurance policies from excluding from coverage
services provided under title two-A of article twenty-five of the
public health law.
Section one amends paragraph (c) of section 3235-a to require that the
insurer provide a municipality with information on the extent of
benefits available to an insured under the policy upon the insurer's
receipt of written notice from the municipality as to its subrogation
rights. The section also amends paragraph (d) of Section 3235-a to
provide that the individualized family services plan, upon
certification by the early intervention official, be deemed to meet
any precertification, preauthorization and medical necessity
requirements imposed on benefits under the policy. Further, section
one adds: paragraph (e) to prohibit insurers from denying claims
based on the location where services are provided. the duration of
the child's condition or that the child's condition is not likely to
improve within a time specified in the policy, the absence of a
referral by a primary care provider, or that the provider is a
non-participating or non-network provider; subsection (f) to provide
that the time of loss for the purposes of filing claims shall be the
date of payment to the contractor by the municipality; and subsection
(g) to require the insurer to issue payment in the amount of the
approved costs for early intervention services.

Section two adds two new subparagraphs to section 2559 of the public
health law.

Section three provides the effective date.

JUSTIFICATION:
Despite Article 25 of the federal Individuals with Disabilities
Education Act (IDEA) which mandates public and private commercial
insurance to be maximized in financing early intervention (EI)
services, reimbursement from third party payers, other than Medicaid,
have been minimal leaving the cost of this entitlement to be paid by
state and municipal tax dollars.

In recognition of the need to improve recoupment of insurance monies
to help pay for EI, the Third Party Reimbursement Task Force of the
New York State Early Invention coordinating council was convened in
1999.


That Task Force examined data on billing and recoupment in 1997 and
found that private insurance collection was at a low rate of 9%. An
updated survey conducted by the New York State Association of County
Health Officials of billing and recoupment in 2000 found that, while
the amount billed to insurers had almost doubled, the recoupment rate
remained a low 11%.

The Task Force also consulted with experts from Massachusetts, Indiana
and Virginia, all states that have included in state law the specific
requirements necessary to ensure insurance payments for EI. Experts
from these three states indicated that requiring insurers to pay for
El services minimally impacted insurance premiums and that insurers
may in fact have saved money in the long run due to the therapeutic
interventions under EI. Experts from the three states confirmed the
Task Force's finding that the single most important factor to improve
collections as well as reducing administrative burdens was
legislation requiring private commercial insurers to pay for EI.

Current insurance law does not include the necessary language to
insure that payments are made nor does the language preclude the
majority of reasons given for ET denials. As a result, it is
necessary that specific language be adopted to fix this problem.

PRIOR LEGISLATIVE HISTORY:
A.3719, 2009 and 2010 referred to insurance. A.4399, 2007 and 2008
referred to insurance, A.1014-A, 2005 and 2006 referred to insurance.
Same as S.4365-A, 2005 and 2006 referred to insurance. A.6760-A, 2003
and 2004 referred to insurance.
Same as S.2410-A 2003 and 2004 referred to insurance. A.11436, 2002
referred to insurance.

New Bill in the Senate

FISCAL IMPLICATIONS:
None to the state, savings for municipalities.

EFFECTIVE DATE:
This act shall take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4013--C

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 14, 2011
                               ___________

Introduced  by Sen. McDONALD -- read twice and ordered printed, and when
  printed to be committed to the Committee  on  Insurance  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to  said  committee  --  committee  discharged,  bill amended, ordered
  reprinted as amended and recommitted to said  committee  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to coverage of early intervention services

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subsection (c) of section 3235-a of the insurance  law,  as
added  by  section  3  of  part  C  of chapter 1 of the laws of 2002, is
amended and a new subsection (e) is added to read as follows:
  (c) Any right of subrogation to benefits which a municipality is enti-
tled in accordance with paragraph (d) of subdivision  three  of  section
twenty-five  hundred  fifty-nine of the public health law shall be valid
and enforceable to the extent benefits are available under any  accident
and health insurance policy. The right of subrogation does not attach to
insurance benefits paid or provided under any accident and health insur-
ance  policy  prior to receipt by the insurer of written notice from the
municipality. UPON THE INSURER'S RECEIPT OF WRITTEN REQUEST  AND  NOTICE
FROM THE MUNICIPALITY THAT SUCH RIGHT OF SUBROGATION HAS BEEN GRANTED TO
SUCH  MUNICIPALITY  AND  THAT  THE INSURED HAS AUTHORIZED THE RELEASE OF
INFORMATION TO THE MUNICIPALITY, THE INSURER SHALL PROVIDE  THE  MUNICI-
PALITY  WITH  INFORMATION  ON  THE  EXTENT  OF BENEFITS AVAILABLE TO THE
COVERED PERSON UNDER SUCH POLICY.
  (E) WRITTEN CLAIM FOR EARLY INTERVENTION  PROGRAM  SERVICES  SHALL  BE
SUBMITTED  BY  THE  MUNICIPALITY  AS  THE  APPROVED  PROVIDER WITHIN ONE
HUNDRED FIFTY DAYS FROM THE DATE OF SERVICE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00328-12-1

S. 4013--C                          2

  S 2.  Paragraph (a) of subdivision 3 of section  2559  of  the  public
health  law  is  amended by adding two new subparagraphs (i) and (ii) to
read as follows:
  (I)  PARENTS  SHALL PROVIDE AND THE MUNICIPALITY SHALL OBTAIN INFORMA-
TION ON ANY PLAN OF INSURANCE UNDER WHICH AN ELIGIBLE CHILD  HAS  COVER-
AGE.
  (II)  PARENTS  SHALL  PROVIDE THE MUNICIPALITY WITH A WRITTEN REFERRAL
FROM A PRIMARY CARE PROVIDER AS DOCUMENTATION, FOR ELIGIBLE CHILDREN, OF
THE MEDICAL NECESSITY OF EARLY INTERVENTION SERVICES.
  S 3. This act shall take effect immediately.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.