senate Bill S5938B

Relates to financial responsibility and reimbursement for payment for early intervention services

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Bill Status


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

  • 20 / Sep / 2013
    • REFERRED TO RULES
  • 04 / Oct / 2013
    • AMEND AND RECOMMIT TO RULES
  • 04 / Oct / 2013
    • PRINT NUMBER 5938A
  • 08 / Jan / 2014
    • REFERRED TO HEALTH
  • 06 / Feb / 2014
    • AMEND AND RECOMMIT TO HEALTH
  • 06 / Feb / 2014
    • PRINT NUMBER 5938B

Summary

Relates to financial responsibility and reimbursement for payment for early intervention services.

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Bill Details

See Assembly Version of this Bill:
A8195A
Versions:
S5938
S5938A
S5938B
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd ยงยง2559 & 2557, Pub Health L

Sponsor Memo

BILL NUMBER:S5938B

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, 2014.

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,
2014, so that payments can be made to providers for services rendered
at that time.

LEGISLATIVE HISTORY:

2013: 5938A -- RULES

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, 2014.

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

                                 5938--B

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                           September 20, 2013
                               ___________

Introduced  by Sens. TKACZYK, ADDABBO, AVELLA, BRESLIN, GIPSON, LATIMER,
  PARKER -- read twice and ordered  printed,  and  when  printed  to  be
  committed  to  the  Committee  on  Rules -- committee discharged, bill
  amended, ordered reprinted as amended and recommitted to said  commit-
  tee  --  recommitted  to  the  Committee  on Health in accordance with
  Senate Rule 6, sec. 8 -- committee discharged, bill  amended,  ordered
  reprinted as amended and recommitted to said committee

AN  ACT to amend the public health law, in relation to financial respon-
  sibility and reimbursement for payment for early intervention services

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

  Section  1. The opening paragraph of 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, is amended to read as follows:
  [Providers of evaluations and early intervention services, hereinafter
collectively  referred  to in this subdivision as "provider" or "provid-
ers",] THE STATE, OR ITS DESIGNATED FISCAL  AGENT  shall  in  the  first
instance  and where applicable, seek payment from all third party payors
including governmental agencies prior to claiming payment from  a  given
municipality  for  evaluations  conducted  under  the  program  and  for
services rendered to eligible children, provided that, the obligation to
seek payment shall not apply to a payment from a third party  payor  who
is  not  prohibited  from  applying  such  payment,  and will apply such
payment, to an annual or lifetime limit specified in the insured's poli-
cy.
  S 2.   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, is
amended to read as follows:
  1. The approved costs for an eligible child who receives an evaluation
and early intervention services pursuant to this title shall be a charge
upon the municipality wherein the eligible child resides AND  THE  STATE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11760-08-4

S. 5938--B                          2

or,  where  the  services are covered by the medical assistance program,
upon the social services district of fiscal responsibility with  respect
to those eligible children who are also eligible for medical assistance.
All  approved  costs  shall  be paid in the first instance [and at least
quarterly] WITHIN THIRTY DAYS by the appropriate governing body or offi-
cer of the municipality AND THE STATE upon vouchers presented and audit-
ed in the same manner as the case of other claims  against  the  munici-
pality.  Notwithstanding  the  insurance  law  or regulations thereunder
relating to the permissible exclusion of  payments  for  services  under
governmental  programs,  no  such  exclusion shall apply with respect to
payments made pursuant to this title. Notwithstanding the insurance  law
or any other law or agreement to the contrary, benefits under this title
shall  be considered secondary to any plan of insurance or state govern-
ment benefit program under which an eligible child  may  have  coverage.
Nothing in this section shall increase or enhance coverages provided for
within an insurance contract subject to the provisions of this title.
  S 3. Subdivision 5 of section 2557 of the public health law is amended
by adding a new paragraph (d) to read as follows:
  (D)  THE  FISCAL  AGENT SHALL, AT LEAST QUARTERLY, CONDUCT A RECONCIL-
IATION OF THIRD PARTY REIMBURSEMENT PURSUANT  TO  SUBDIVISION  THREE  OF
SECTION  TWENTY-FIVE  HUNDRED  FIFTY-NINE  OF  THIS ARTICLE, AND PROVIDE
REIMBURSEMENT IN EQUAL PROPORTION TO THE  STATE  AND  MUNICIPALITY  UPON
VOUCHERS FOR EARLY INTERVENTION SERVICES THAT HAVE BEEN PAID.
  S  4.  This  act  shall take effect immediately and shall be deemed to
have been in full force and effect on and after June 1, 2014.

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