senate Bill S6002

Provides for the payment by the state of the costs of an evaluation and early intervention services to eligible children

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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

  • 06 / Dec / 2013
    • REFERRED TO RULES
  • 08 / Jan / 2014
    • REFERRED TO HEALTH
  • 14 / Jan / 2014
    • REPORTED AND COMMITTED TO FINANCE
  • 20 / May / 2014
    • 1ST REPORT CAL.852
  • 21 / May / 2014
    • 2ND REPORT CAL.
  • 28 / May / 2014
    • ADVANCED TO THIRD READING
  • 20 / Jun / 2014
    • COMMITTED TO RULES

Summary

Provides for the payment by the state of the costs of an evaluation and early intervention services to eligible children.

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Bill Details

Versions:
S6002
Legislative Cycle:
2013-2014
Current Committee:
Senate Rules
Law Section:
Public Health Law
Laws Affected:
Amd ยงยง2557 & 2559, Pub Health L

Votes

15
0
15
Aye
0
Nay
0
aye with reservations
0
absent
0
excused
0
abstained
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Sponsor Memo

BILL NUMBER:S6002

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

PURPOSE OR GENERAL IDEA OF BILL:

To clarify the role of the state's early intervention (EI) fiscal
agent and ensure that infants and toddlers in New York State have
timely access to EI services.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of the bill amends subdivision 1 of Section 2557 of the
Public Health Law to provide that EI providers must be paid in full at
the State EI rate by the state or the State Fiscal Agent (SFA)
designated by the New York State Department of Health (NYS DOH) within
30 days of the receipt by the state or its SFA of an initial claim
from a provider.

Section 2 of the bill amends paragraph (a) of subdivision (3) of

Section 2559 of the Public Health Law to require the SFA to conduct
fiscal management and payment of claims for the EI program to:

*seek payment on behalf of EI providers directly from all third payors
including, the Medicaid program; and
*track claims submitted to all third party payers and file and conduct
all appeals of payment denials directly with all third party payors.

Section 3 of the bill adds a new subparagraph (iv) to paragraph (a) of
subdivision (3) of Section 2559 of the Public Health to require the
SFA to conduct reconciliation at least quarterly and to reimburse the
State and municipalities for their share.

Section 4 of the bill amends paragraph (d) of subdivision (3) of
Section 2559 of the Public Health Law to require the SFA instead of
the EI provider to be subrogated to any rights that a person may have
or be entitled to from third party reimbursement for EI services.

Section 5 of the bill provides that this act shall take effect 60 days
after it is signed into law provided 1) it shall apply to EI provider
claims that have not been paid in full prior to the effective date and
2) effective immediately the Department shall take all actions
necessary to effectuate the act on its effective date

JUSTIFICATION:

The 2012-13 State Budget (Section 11 of Part A of Chapter 56 of the
Laws of 2012) transferred the responsibility for EI billing from
county government to a State Fiscal Agent under contract with NYS DOH,
effective April 1, 2013 in order to achieve a more efficient and
effective process with the expectation that a larger proportion of EI
claims would be paid by third party insurance. This bill makes
clarifying amendments to ensure the original intent of making a more
efficient and effective process are in fact realized.


Under the new system that has been implemented, providers are caught
between patients, insurers and the fiscal agent awaiting decisions and
information that is often out of their control. As a result they are
experiencing devastating payment delays and administrative burdens
which have made the EI program fiscally unsustainable for some
providers. Access to services for infants and children who rely on
this program for critical therapies may be seriously jeopardized as
providers leave the program. This was not the intended consequence of
the creation of a fiscal agent in the 2013-14 budget.

Providers are not able to make payroll or routine business decisions
about the number of employees, salary and benefits, or caseload size
if they cannot predict the level and timeliness of revenue from third
party payors. Many providers are unable to pay their personal bills
and are maxing out credit limits to support themselves and their
agencies. Others are experiencing limits to their business' line of
credit and increased interest rates because the problems have
continued for months and the creditors do not see a solution in sight.

Tracking insurance claims has become a second full time job for
providers. Many do not have the resources, infrastructure, and staff
to navigate the complexities of commercial insurance and Medicaid
payment systems. Providers receive no additional payment for this
increased workload. In fact, EI has not experienced a rate increase in
16 years, but has had reimbursement rates cut in 2010 and again in
2011.

This bill clarifies the legislative intent and thereby preserves
access to EI services for eligible infants and toddlers by requiring
the SFA to pay providers within 30 days of the receipt of a commercial
insurance claim from a provider, as the counties had done in the past.
It also clarifies that the SFA shall pursue provider claims and
payments and handle all appeals of payment denials by insurance
companies in order to enhance third party reimbursement for certain EI
services. Finally, the legislation provides an effective date that
both gives the Department time to make the necessary changes in the
payment system, while providing a remedy for providers to be paid for
unpaid claims dating back to the April 1, 2013 implementation of a
SFA.

PRIOR LEGISLATIVE HISTORY:

None.

FISCAL IMPLICATIONS:

None. Continued delays and lack of access to preventative services
will actually increase long, term costs for special education services
for school age children. Additionally, a single SFA submitting and
appealing commercial insurance claims statewide will be able to
leverage greater reimbursements than the counties or providers which
was the original intention.

EFFECTIVE DATE:

This act shall take effect 60 days after it is signed into law
provided 1) it shall apply to EI provider claims that have not been


paid in full prior to the effective date and 2) effective immediately
the Department shall take all actions necessary to effectuate the act
on its effective date.

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

                                  6002

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            December 6, 2013
                               ___________

Introduced by Sens. HANNON, SEWARD, BONACIC, BOYLE, CARLUCCI, DeFRANCIS-
  CO,  FARLEY,  GOLDEN,  GRISANTI,  LARKIN,  LAVALLE,  LITTLE,  MAZIARZ,
  RITCHIE -- read twice and ordered printed,  and  when  printed  to  be
  committed to the Committee on Rules

AN  ACT  to  amend  the  public health law, in relation to the financial
  responsibility for and reimbursement of payment for early intervention
  services by the state

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

  Section  1. 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
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 FULL AT  THE  STATE  APPROVED  EARLY
INTERVENTION  RATE  in the first instance [and at least quarterly by the
appropriate governing body or officer of the municipality upon  vouchers
presented  and  audited  in  the same manner as the case of other claims
against the municipality] BY THE STATE OR ITS DESIGNATED FISCAL AGENT TO
A PROVIDER WITHIN THIRTY DAYS OF THE RECEIPT BY THE STATE OR ITS  DESIG-
NATED  STATE  FISCAL AGENT OF AN INITIAL CLAIM FROM A PROVIDER.  WHERE A
PROVIDER'S ASSIGNMENT IS CALLED FOR UNDER PARAGRAPH (D)  OF  SUBDIVISION
THREE  OF  SECTION  TWENTY-FIVE  HUNDRED  FIFTY-NINE  OF THIS TITLE, THE
ASSIGNMENT SHALL BE PART OF THE PROVIDER'S CLAIM.   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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13146-02-3

S. 6002                             2

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 government 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  2.    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.    THE STATE OR ITS DESIGNATED FISCAL AGENT SHALL BE RESPONSIBLE FOR
FILING AND CONDUCTING ALL APPEALS OF PAYMENT DENIALS BY ALL THIRD  PARTY
PAYORS INCLUDING GOVERNMENTAL AGENCIES, AND TRACKING CLAIMS SUBMITTED TO
ALL THIRD PARTY PAYORS INCLUDING GOVERNMENTAL AGENCIES.
  S  3.  Paragraph  (a)  of  subdivision 3 of section 2559 of the public
health law is amended by adding a  new  subparagraph  (iv)  to  read  as
follows:
  (IV)  THE  FISCAL AGENT SHALL, AT LEAST QUARTERLY, CONDUCT A RECONCIL-
IATION OF THIRD PARTY REIMBURSEMENT PURSUANT  TO  THIS  SUBDIVISION  AND
PROVIDE  REIMBURSEMENT  AT  LEVELS  IN ACCORDANCE WITH THIS TITLE TO THE
STATE AND MUNICIPALITIES.
  S 4. Paragraph (d) 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:
  (d) A municipality, or its designee, and [a provider] THE STATE OR ITS
DESIGNATED  FISCAL  AGENT  shall  be  subrogated,  to  the extent of the
expenditures by such municipality or  for  early  intervention  services
furnished  to  persons  eligible  for  benefits under this title, to any
rights such  person  may  have  or  be  entitled  to  from  third  party
reimbursement. The [provider] STATE OR ITS DESIGNATED FISCAL AGENT shall
submit  notice  to the insurer or plan administrator of [his or her] ITS
exercise of such right of subrogation [upon the provider's assignment as
the early intervention service provider for the  child].  The  right  of
subrogation  does  not  attach  to  benefits  paid or provided under any
health insurance policy or health benefits  plan  prior  to  receipt  of
written  notice  of the exercise of subrogation rights by the insurer or
plan administrator providing such benefits.
  S 5. This act shall take effect on the sixtieth  day  after  it  shall
have  become  a  law,  and (a) shall apply to any claim for payment by a
provider for services under title 2-A of article 25 of the public health
law that has not been fully paid pursuant to such title on or after such
effective date, whether filed before or after the effective date of this
act and (b) effective immediately, the commissioner of health is author-
ized and directed to promulgate regulations and take all actions  neces-
sary  and  appropriate  to  implement  the provisions of this act on its
effective date.

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