BILL NUMBER:S5938

TITLE OF BILL:  An act to amend the public health law, in relation to
financial responsibility and reimbursement for payment for early
intervention services

PURPOSE:

This bill amends paragraph (a) of subdivision 3 of section 2559 of the
public health law, as amended by section 11 of part A of Chapter 56 of
the laws of 2012, and subdivision 1 of section 2557 of the public
health law, as amended by section 4 of part C of Chapter 1 of the laws
of 2002, to require the state of New York or its fiscal agent to
collect payment from third party payers in the Early Intervention
Program, and to make payment in full on proper claims submitted by
providers within 30 days.

SUMMARY OF PROVISIONS:

Section 1 of the bill amends paragraph (a) of subdivision 3 of section
2559 of the public health law, as amended by section 11 of part A of
Chapter 56 of the laws of 2012, by requiring the state of New York, or
its designated fiscal agent, to seek payment in the first instance
from all third party payers in the early intervention program.

Section 2 of the bill directs payment to be made within 30 days of the
              

date on which the municipality pays the claim for the approved costs
of Early Intervention Services.

Section 3 of the bill makes the bill to be effective immediately, and
includes a provision that the act is deemed to be in full force and
effect on or after June 1 2013.

JUSTIFICATION:

In 2012, changes were made to the funding of Early Intervention
Services, particularly in the provision of occupational, speech and
other provider directed therapies. The purpose of the changes was to
ensure that NYS was receiving the full benefit of, and cost reductions
appurtenant to, third party insurance reimbursement for covered
services.

Under existing law, payment for the services rendered are delayed for
an extended period of time, and only reimbursed initially up to 50%.
Providers of these services, were, for the first time, required to
obtain insurance reimbursement themselves.

Prior to the 2012 statutory changes, local government units were
responsible for the collection of third party payments from health
insurance companies and Medicaid for the appropriate share of the
reimbursable costs of those services. At no time prior to the
enactment of this legislation were the providers required to collect
these third party payments.

By changing the law, the statute has shifted the onerous and time
consuming burden to the providers, many of whom are sole
proprietorships. They do not have the requisite staff or systems


required for coding, document submission or appeals that are part of
the third party payment system.

As a result, many of the providers are unable to fulfill this new
mandate, and large numbers have received no payments for services
rendered since April 2013. The ability to provide early intervention
services to children across the state is in jeopardy.

This legislation would require the state, or its fiscal agent, to
pursue these funds, removing the unfunded mandate from local
businesses providing these early intervention health care services.
Recognizing that the goal of the original statute was to capture third
party payment and reduce the state's financial burden, the state or
the fiscal agent is the appropriate entity to pursue this
reimbursement.

This legislation provides for more timely payment of the claims
submitted by contracted providers, yet maintains the requirement that
the providers and counties assist the state or the fiscal agent with
the efforts to recoup the funds from the third party payers.

It also deems the new law to be in full force and effect as of June 1,
2013, so that payments can be made to providers for services rendered
at that time.

LEGISLATIVE HISTORY:

2013: New bill.

FISCAL IMPLICATIONS:

None anticipated.

EFFECTIVE DATE:

This act shall take effect immediately; provided that the new
provisions of paragraph (a) of subdivision 3 of section 2559 of the
public health law, and subdivision 1 of section 2557 of the public
health law, shall be deemed to have been in full force and effect on
or after June 1, 2013.

                                BILL NUMBER:S5938A

TITLE OF BILL:  An act to amend the public health law, in relation to
financial responsibility and reimbursement for payment for early
intervention services

PURPOSE:

This bill amends paragraph (a) of subdivision 3 of section 2559 of the
public health law, as amended by section 11 of part A of Chapter 56 of
the laws of 2012, and subdivision 1 of section 2557 of the public
health law, as amended by section 4 of part C of Chapter 1 of the laws
of 2002, to require the state of New York or its fiscal agent to
collect payment from third party payors in the Early Intervention
Program, and to make payment in full on proper claims submitted by
providers within 30 days.

SUMMARY OF PROVISIONS:

Section 1 of the bill amends paragraph (a) of subdivision 3 of section
2559 of the public health law, as amended by section 11 of part A of
Chapter 56 of the laws of 2012, by requiring, the state of New York,
or its designated fiscal agent, to seek payment in the first instance
from all third party payors in the early intervention program.

Section 2 of the bill directs payment to be made within 30 days of the
              

date on which the municipality pays the claim for the approved costs
of Early Intervention Services. It also clarifies that the net costs
of Early Intervention services are to be borne equally by the state
and counties.

Section 3 of the bill requires the fiscal agent to do at least
quarterly reconciliations of health insurance and Medicaid
reimbursement, and provide refunds to the state and counties in equal
shares.

Section 4 of the bill makes the bill to be effective immediately, and
includes a provision that the act is deemed to be in full force and
effect on or after June 1, 2013.

JUSTIFICATION:

In 2012, changes were made to the funding of Early Intervention
Services, particularly in the provision of occupational, speech and
other provider directed therapies. The purpose of the changes was to
ensure that NYS was receiving the full benefit of, and cost reductions
appurtenant to, third party insurance reimbursement for covered
services.

Under existing law, payment for the services rendered are delayed for
an extended period of time, and only reimbursed initially up to 50%.
Providers of these services, were, for the first time, required to
obtain insurance reimbursement themselves.

Prior to the 2012 statutory changes, local government units were
responsible for the collection of third party payments from health
insurance companies and Medicaid for the appropriate share of the


reimbursable costs of those services. At no time prior to the
enactment of this legislation were the providers required to collect
these third party payments.

By changing the law, the statute has shifted the onerous and time
consuming burden to the providers, many of whom are sole
proprietorships. They do not have the requisite staff or systems
required for coding, document submission or appeals that are part of
the third party payment system.

As a result, many of the providers are unable to fulfill this new
mandate, and large numbers have received no payments for services
rendered since April 2013. The ability to provide early intervention
services to children across the state is in jeopardy.

This legislation would require the state, or its fiscal agent, to
pursue these funds, removing the unfunded mandate from local entities
providing these early intervention health care services. Recognizing
that the goal of the original statute was to capture third party
payment and reduce the state's financial burden, the state or the
fiscal agent is the appropriate entity to pursue this reimbursement.

Upon obtaining, third party payment from the insurers, the law would
further require the fiscal agent to complete a reconciliation of
reimbursements, and provide payment back to the state and counties in
equal shares.

This legislation provides for more timely payment of the claims
submitted by contracted providers, yet maintains the requirement that
the providers and counties assist the state or the fiscal agent with
the efforts to recoup the funds from the third party payors.

It also deems the new law to be in full force and effect as of June 1,
2013, so that payments can be made to providers for services rendered
at that time.

LEGISLATIVE HISTORY:

2013: New bill.

FISCAL IMPLICATIONS:

None anticipated.

EFFECTIVE DATE:

This act shall take effect immediately; provided that the new
provisions of paragraph (a) of subdivision 3 of section 2559 of the
public health law, and subdivision 1 of section 2557 of the public
health law, shall be deemed to have been in full force and effect on
or after June 1, 2013.