Assembly Bill A4058A

2009-2010 Legislative Session

Provides for funding of early intervention services

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Archive: Last Bill Status - In Assembly Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jul 01, 2010	held for consideration in ways and means
Feb 02, 2010	reported referred to ways and means
Jan 19, 2010	print number 4058a
Jan 19, 2010	amend and recommit to health
Jan 06, 2010	referred to health
Feb 10, 2009	reported referred to ways and means
Jan 29, 2009	referred to health

Bill Amendments

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2009-A4058 - Details

Current Committee:: Assembly Ways And Means
Law Section:: Public Health Law
Laws Affected:: Add §2807-o, amd §§2807-s, 2557 & 2559, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:: A812

2009-A4058 - Summary

Provides for state grant funding to municipalities for early intervention services for toddlers with disabilities and their families.

2009-A4058 - Bill Text download pdf

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

                                  4058

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 29, 2009
                               ___________

Introduced  by  M. of A. PAULIN, GOTTFRIED, BRADLEY, CAHILL, CANESTRARI,
  CLARK,  COOK,  EDDINGTON,  FIELDS,  GALEF,  GUNTHER,  JACOBS,  JAFFEE,
  LIFTON, MARKEY, MAYERSOHN, REILLY, SCHROEDER, LAVINE, LATIMER, MAGNAR-
  ELLI,  DINOWITZ,  PHEFFER -- Multi-Sponsored by -- M. of A. ESPAILLAT,
  KOON, MAISEL, McENENY, MOLINARO, SWEENEY, TOWNS, WEINSTEIN, WEISENBERG
  -- read once and referred to the Committee on Health

AN ACT to amend the public health law,  in  relation  to  funding  early
  intervention services

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

  Section 1. The public health law is amended by adding  a  new  section
2807-o to read as follows:
  S  2807-O.  EARLY  INTERVENTION  SERVICES  POOL.  1.  DEFINITIONS. THE
FOLLOWING WORDS OR PHRASES AS  USED  IN  THIS  SECTION  SHALL  HAVE  THE
FOLLOWING MEANINGS:
  (A)  "EARLY INTERVENTION SERVICES" SHALL MEAN SERVICES DELIVERED TO AN
ELIGIBLE CHILD, PURSUANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN  UNDER
THE EARLY INTERVENTION PROGRAM.
  (B)  "EARLY  INTERVENTION  PROGRAM"  SHALL MEAN THE EARLY INTERVENTION
PROGRAM FOR TODDLERS WITH DISABILITIES AND THEIR FAMILIES AS CREATED  BY
TITLE TWO-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
  (C)  "MUNICIPALITY"  SHALL  MEAN ANY COUNTY OUTSIDE OF THE CITY OF NEW
YORK OR THE CITY OF NEW YORK.
  2. GRANTS FOR EARLY INTERVENTION SERVICES. (A) THE COMMISSIONER SHALL,
FROM FUNDS ALLOCATED FOR SUCH PURPOSE UNDER PARAGRAPH (G) OF SUBDIVISION
SIX OF SECTION TWENTY-EIGHT HUNDRED SEVEN-S OF THIS ARTICLE, MAKE GRANTS
TO MUNICIPALITIES FOR THE DELIVERY OF EARLY INTERVENTION SERVICES.  SUCH
GRANTS  SHALL  BE  DEEMED  REIMBURSEMENT FROM THIRD PARTY PAYORS TO SUCH
MUNICIPALITIES FOR THE PURPOSES OF THE EARLY INTERVENTION PROGRAM.
  (B) GRANTS UNDER THIS SUBDIVISION SHALL BE AWARDED  TO  MUNICIPALITIES
BY  THE  COMMISSIONER.  EACH  MUNICIPALITY SHALL RECEIVE A SHARE OF SUCH
GRANTS EQUAL TO ITS PROPORTIONATE SHARE OF THE TOTAL APPROVED  STATEWIDE
DOLLARS  NOT  REIMBURSABLE  BY  THE  MEDICAL  ASSISTANCE PROGRAM PAID TO
PROVIDERS OF EARLY INTERVENTION SERVICES BY MUNICIPALITIES, NOT  INCLUD-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03304-02-9

A. 4058                             2

ING  PROVIDERS  OF  TRANSPORTATION,  ON  ACCOUNT  OF  EARLY INTERVENTION
SERVICES, IN THE LAST COMPLETE STATE FISCAL YEAR FOR WHICH SUCH DATA  IS
AVAILABLE.
  S  2.  Subdivision  6  of  section  2807-s of the public health law is
amended by adding two new paragraphs (g) and (h) to read as follows:
  (G) A FURTHER GROSS STATEWIDE AMOUNT FOR TWO THOUSAND TEN SHALL BE ONE
HUNDRED MILLION DOLLARS.
  (H) THE AMOUNT SPECIFIED IN PARAGRAPH (G) OF THIS SUBDIVISION SHALL BE
ALLOCATED AMONG THE MUNICIPALITIES BASED ON EACH MUNICIPALITY'S SHARE OF
EARLY INTERVENTION PROGRAM EXPENDITURES NOT REIMBURSABLE BY THE  MEDICAL
ASSISTANCE  PROGRAM  FOR  THE  LATEST TWELVE MONTH PERIOD FOR WHICH SUCH
DATA IS AVAILABLE.
  S 3. Subdivision 7 of section 2807-s  of  the  public  health  law  is
amended by adding a new paragraph (d) to read as follows:
  (D)  FUNDS  SHALL  BE ADDED TO THE FUNDS COLLECTED BY THE COMMISSIONER
FOR DISTRIBUTION IN ACCORDANCE WITH SECTION TWENTY-EIGHT HUNDRED SEVEN-O
OF THIS ARTICLE, IN THE FOLLOWING AMOUNT:  ONE HUNDRED  MILLION  DOLLARS
FOR  THE PERIOD JANUARY FIRST, TWO THOUSAND TEN THROUGH DECEMBER THIRTY-
FIRST, TWO THOUSAND TEN.
  S 4. Subdivision 1 and paragraphs (j) and  (k)  of  subdivision  4  of
section  2557  of  the  public  health  law, subdivision 1 as amended by
section 4 of part C of chapter 1 of the laws of 2002 and paragraphs  (j)
and  (k)  of subdivision 4 as amended by section 7 of part B3 of chapter
62 of the laws of 2003, are 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 or,  where  the
services  are covered by the medical assistance program, upon the social
services district of fiscal responsibility with respect to those  eligi-
ble  children who are also eligible for medical assistance. All approved
costs shall be paid 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.  Notwithstanding  the insurance law or regu-
lations 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 government benefit program under which an eligible  child  may
have coverage. [Nothing in this section shall increase or enhance cover-
ages provided for within an insurance contract subject to the provisions
of this title.]
  (j)  The  number of children that [have third party reimbursement] ARE
COVERED BY THE MEDICAL ASSISTANCE PROGRAM;
  (k) The number of claims submitted to [third party payors] THE MEDICAL
ASSISTANCE PROGRAM by municipality. The percentage of claims  denied  by
[third party payors] THE MEDICAL ASSISTANCE PROGRAM. The reasons for the
denials.
  S  5. Subdivision 2 of section 2557 of the public health law, as added
by chapter 428 of the laws of 1992, is amended to read as follows:
  2. The department shall reimburse the approved costs paid by a munici-
pality for the purposes of this title, other than those reimbursable  by
the  medical assistance program [or by third party payors], in an amount
of fifty percent of the amount expended in accordance with the rules and
regulations of the commissioner. Such state reimbursement to the munici-

A. 4058                             3

pality shall not be paid prior to April first of the year in  which  the
approved costs are paid by the municipality.
  S  6. The section heading of section 2559 of the public health law, as
added by chapter 428 of the laws of 1992, is amended to read as follows:
  [Third  party  insurance  and  medical]  MEDICAL  assistance   program
payments.
  S  7. Subdivision 3 of section 2559 of the public health law, as added
by chapter 428 of the laws of 1992, paragraph (a) as amended  and  para-
graph  (d)  as  added  by chapter 231 of the laws of 1993, is amended to
read as follows:
  3. (a) Providers of early  intervention  services  and  transportation
services  shall in the first instance and where applicable, seek payment
from [all  third  party  payors  including  governmental  agencies]  THE
MEDICAL  ASSISTANCE PROGRAM prior to claiming payment from a given muni-
cipality for services rendered to eligible children, provided that,  for
the  purpose  of seeking payment from the medical assistance program [or
from other third party payors], the municipality  shall  be  deemed  the
provider  of  such  early  intervention  services to the extent that the
provider  has  promptly  furnished  to  the  municipality  adequate  and
complete  information necessary to support the municipality billing, and
provided further 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 policy] WHERE THE INSURED IS NOT ELIGI-
BLE FOR MEDICAL ASSISTANCE PURSUANT TO THE SOCIAL SERVICES LAW.
  (b) [The commissioner, in consultation with the director of budget and
the superintendent of insurance, shall promulgate regulations  providing
public  reimbursement  for  deductibles and copayments which are imposed
under an insurance policy or health benefit plan to the extent that such
deductibles  and  copayments  are  applicable  to   early   intervention
services.
  (c)  Payments  made for early intervention services under an insurance
policy or health benefit plan which are provided  as  part  of  an  IFSP
pursuant  to  section twenty-five hundred forty-five of this title shall
not be applied by the insurer or plan administrator against any  maximum
lifetime  or  annual  limits  specified in the policy or health benefits
plan, pursuant to section eleven of the chapter of the laws of  nineteen
hundred ninety-two which added this title.
  (d)]  A  municipality,  or  its  designee, shall be subrogated, to the
extent of the expenditures by such municipality 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 MEDICAL ASSISTANCE PROGRAM.  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].  NOTWITHSTANDING ANY INCONSISTENT PROVISION OF
THIS  TITLE,  EXCEPT  AS PROVIDED FOR HEREIN, NO THIRD PARTY PAYOR OTHER
THAN THE MEDICAL ASSISTANCE PROGRAM SHALL BE REQUIRED TO  REIMBURSE  FOR
EARLY INTERVENTION SERVICES PROVIDED UNDER THIS TITLE.
  S  8.  This  act shall take effect January 1, 2010; provided, however,
that the amendments to section 2807-s of the public health law  made  by
sections  two  and  three of this act shall not affect the expiration of
such section and shall be deemed to expire therewith.

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2009-A4058A (ACTIVE) - Details

Current Committee:: Assembly Ways And Means
Law Section:: Public Health Law
Laws Affected:: Add §2807-o, amd §§2807-s, 2557 & 2559, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:: A812

2009-A4058A (ACTIVE) - Summary

Provides for state grant funding to municipalities for early intervention services for toddlers with disabilities and their families.

2009-A4058A (ACTIVE) - Sponsor Memo

                                BILL NUMBER:A4058A

TITLE  OF  BILL:   An act to amend the public health law, in relation to
funding early intervention services

PURPOSE OR GENERAL IDEA OF BILL: To provide a  system  that  streamlines
the  process  by  which  the  funds are distributed to municipalities to
finance early intervention programs, thereby providing vital  relief  to
the  municipalities  across  the  state, and to improve their ability to
more effectively administer early intervention services to children  who
need such services.

SUMMARY OF SPECIFIC PROVISIONS: Section one amends the public health law
by  adding a new section 2807-o that provides definitions for terms used
in this section of law. Section one also provides that the  commissioner
shall  make  grants  to  municipalities for the delivery of early inter-
vention services. Such grants shall be deemed reimbursements from  third
party  payors to the municipalities and shall be a share of grants equal
to the municipality's proportionate share of the total  approved  state-
wide dollars not reimbursable by the medical assistance program, paid by
municipalities  to  providers  of early intervention services (excluding
providers of transportation based upon the last  complete  state  fiscal
year for which such data available.

Section  two amends subdivision 6 of section 2807-s of the public health
law by adding two new paragraphs (g) and  (h).  Paragraph  (g)  provides

that  a  further gross statewide amount for two thousand eleven shall be
one hundred million dollars. Paragraph (h) provides that the one hundred
million dollars specified in paragraph (g) shall  be  allocated  to  the
municipalities  based on each municipality's share of early intervention
program expenditures not reimbursable by the medical assistance  program
for the latest twelve month period for which such data is available.

Section  three  amends  subdivision  7  of  section 2607-s of the public
health law by adding a new paragraph (d) that provides that the  commis-
sioner shall collect funds, to be distributed in accordance with section
2807-o,  in  the  amount  of  one hundred million dollars for the period
January first, two thousand eleven through  December  thirty-first,  two
thousand  eleven.   Section four amends subdivision 1 and paragraphs (j)
and (k) of subdivision 4 of section  2557  of  the  public  health  law.
Subdivision  1  provides that benefits under this title shall be consid-
ered secondary to any state government benefit program  under  which  an
eligible  child  may have coverage. Paragraph (j) requires the number of
children that are covered by the medical assistance program, rather than
those who have third party reimbursement, and paragraph (k) requires the
number of claims submitted to the  medical  assistance  program,  rather
than  third  party  payors,  and  the percentage of claims denied by the
medical assistance program, rather than third party payors.

Section five amends subdivision 2 of section 2557 of the  public  health
law  to  provide  that the department shall reimburse the approved costs
paid by a municipality other than  those  reimbursable  by  the  medical

assistance  program  (not third party payors) in an amount of 50% of the
amount expended.

Section  six  provides  that the section .heading of section 2559 of the
public health  law  is  amended  to  read  "Medical  assistance  program
payments."

Section  seven amends subdivision 3 of section 2559 of the public health
law to provide that providers shall first seek payment from the  medical
assistance  program, not third party payors including governmental agen-
cies, prior  to  claiming  payment  from  a  municipality  for  services
rendered,  though  not  when  the  insured  is  not eligible for medical
assistance pursuant to the social services law.  Section  seven  deletes
paragraphs  (b)  (requires  the  commissioner  to promulgate regulations
providing public reimbursement for deductibles  and  copayments  imposed
under an insurance policy or health benefit plan to the extent that such
deductibles   and   copayments  are  applicable  to  early  intervention
services) and (c) (payments made for early intervention  services  under
an  insurance  policy or health benefit plan provided as part of an IFSP
shall not be applied against any maximum lifetime or annual limits spec-
ified in the policy or health benefits plan). In addition, section seven
provides that a municipality shall be subrogated to the  extent  of  its
expenditures  for  early  intervention  services  furnished  to eligible
persons to the rights such person may have from the  medical  assistance
program (rather than from third party reimbursement). Except as provided
in  this article, no third party payor other than the medical assistance
program shall be required to reimburse for early intervention services.

Section eight provides the effective date.

JUSTIFICATION: The early intervention'  program  was  established  under
Public  Health  Law and the federal Individuals with Disabilities Educa-
tion Act (IDEA) to enhance the development of infants and toddlers  from
birth  to  age three who have a significant developmental delay or disa-
bility as well as enhance the capacity of families to meet their special
needs. The program seeks to identify and evaluate as early  as  possible
those  infants and toddlers whose healthy development is compromised and
provide for appropriate therapeutic and supportive-services.

With early intervention, we can reduce the number of children with disa-
bilities or reduce the severity of their disabling conditions.

All early intervention (El) services must be provided to eligible  chil-
dren  at no cost to their families. The EI program is financed through a
combination of state and county funds, Medicaid  and  commercial  insur-
ance.    Yet although Public Health Law and IDEA Mandate that public and
private commercial insurance be  maximized  in  financing  El  services,
reimbursement  from  third  party  payers, other than Medicaid, has been
minimal, leaving the cost of this entitlement to be paid  by  state  and
municipal tax dollars.

In  2005;  an  aggregate  893',000  claims  were submitted to commercial
insurers; 70% of the claims were denied. Further, according to a  survey
by  the  New  York-State Association of County Health Officials, for the
period July 2003 to June 2004, $75.5 million in claims for  EI  services
were filed with commercial insurers, of which $10.6 million, or 14%, was
paid.  Counties, who are required by the state to finance and administer
the EI program, are entitled to be reimbursed by the state  for  50%  of
their unreimbursed costs for EI services (36% for administration costs).
Counties  have billed private insurers approximately $100 million, over-
shadowing the aggregate costs billed to Medicaid. The partial funding by
the state, combined with the low rate of  recoupment  from  third  party
insurers,  has  required  municipalities to bear an estimated 43% of the
costs of providing EI services.

To require municipalities to bear such  a  significant  portion  of  the
costs  of the program where the number of children served as well as the
level of services provided continues to increase imposes  a  significant
strain on local budgets. In New York City alone, for the last six months
of  2005,  an  estimated $213.1 million was incurred for EI services, of
which $800,000 was paid by commercial insurance.   Whereas  in  1993  to
1994,  the  first  year the EI program became effective, the costs of RI
services for the entire state  was  $40  million.  Since  a  substantial
portion  of  municipal  budgets  must  be  spent on EI services, munici-
palities must face a shrinking balance of available funds, forcing  them
to decrease or eliminate altogether other needed services.

Recognizing  that  the Current structure of financing EI costs is inade-
quate, this bill provides a different  approach  to  funding.  The  bill
would  set  up a statewide pool from which municipalities would be allo-
cated funds to pay RI costs. By allowing for the  direct  allocation  of
funds  to  municipalities from the statewide pool, we will eliminate the
unwieldy and inefficient step of requiring municipalities (in the  cases
where  the  insured  is  not  eligible  for  medical assistance) to seek
reimbursement of EI costs first from third party insurers and then, only
upon denial or other disposition of the claim, from the state. In  cases
where  the  insured  is  eligible for medical assistance, municipalities
will remain obligated to  seek  reimbursement  first  from  the  medical
assistance program.

Making funds readily available and streamlining the process by which the
funds are distributed to municipalities will provide vital relief to the
municipalities across the state that have been struggling to finance the
EI  program and thereby improve their ability to more effectively admin-
ister EI services to children who need those services.

PRIOR LEGISLATIVE HISTORY: A.6814-A, 2007 and 2008 recommitted  to  ways
and means.

FISCAL IMPLICATIONS: Approximately $50 million to the state.

EFFECTIVE  DATE:  This  act shall take effect January 1, 2011; provided,
however, that the amendments to section 2607-s of the public health  law

made  by sections two and three of this act shall not affect the expira-
tion of such section and shall be deemed to expire therewith.

2009-A4058A (ACTIVE) - Bill Text download pdf

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

                                 4058--A

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 29, 2009
                               ___________

Introduced  by  M.  of  A. PAULIN, GOTTFRIED, CAHILL, CANESTRARI, CLARK,
  COOK, FIELDS, GALEF, GUNTHER, JACOBS, JAFFEE, LIFTON,  MARKEY,  MAYER-
  SOHN,  REILLY, SCHROEDER, LAVINE, LATIMER, MAGNARELLI, DINOWITZ, PHEF-
  FER -- Multi-Sponsored by -- M. of A. ESPAILLAT, KOON, MAISEL,  McENE-
  NY,  MOLINARO,  SWEENEY, TOWNS, WEINSTEIN, WEISENBERG -- read once and
  referred to the Committee on Health -- recommitted to the Committee on
  Health in accordance  with  Assembly  Rule  3,  sec.  2  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN  ACT  to  amend  the  public health law, in relation to funding early
  intervention services

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

  Section  1.  The  public health law is amended by adding a new section
2807-o to read as follows:
  S 2807-O.  EARLY  INTERVENTION  SERVICES  POOL.  1.  DEFINITIONS.  THE
FOLLOWING  WORDS  OR  PHRASES  AS  USED  IN  THIS SECTION SHALL HAVE THE
FOLLOWING MEANINGS:
  (A) "EARLY INTERVENTION SERVICES" SHALL MEAN SERVICES DELIVERED TO  AN
ELIGIBLE  CHILD, PURSUANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER
THE EARLY INTERVENTION PROGRAM.
  (B) "EARLY INTERVENTION PROGRAM" SHALL  MEAN  THE  EARLY  INTERVENTION
PROGRAM  FOR TODDLERS WITH DISABILITIES AND THEIR FAMILIES AS CREATED BY
TITLE TWO-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
  (C) "MUNICIPALITY" SHALL MEAN ANY COUNTY OUTSIDE OF THE  CITY  OF  NEW
YORK OR THE CITY OF NEW YORK.
  2. GRANTS FOR EARLY INTERVENTION SERVICES. (A) THE COMMISSIONER SHALL,
FROM FUNDS ALLOCATED FOR SUCH PURPOSE UNDER PARAGRAPH (G) OF SUBDIVISION
SIX OF SECTION TWENTY-EIGHT HUNDRED SEVEN-S OF THIS ARTICLE, MAKE GRANTS
TO  MUNICIPALITIES FOR THE DELIVERY OF EARLY INTERVENTION SERVICES. SUCH

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03304-03-0

A. 4058--A                          2

GRANTS SHALL BE DEEMED REIMBURSEMENT FROM THIRD  PARTY  PAYORS  TO  SUCH
MUNICIPALITIES FOR THE PURPOSES OF THE EARLY INTERVENTION PROGRAM.
  (B)  GRANTS  UNDER THIS SUBDIVISION SHALL BE AWARDED TO MUNICIPALITIES
BY THE COMMISSIONER. EACH MUNICIPALITY SHALL RECEIVE  A  SHARE  OF  SUCH
GRANTS  EQUAL TO ITS PROPORTIONATE SHARE OF THE TOTAL APPROVED STATEWIDE
DOLLARS NOT REIMBURSABLE BY  THE  MEDICAL  ASSISTANCE  PROGRAM  PAID  TO
PROVIDERS  OF EARLY INTERVENTION SERVICES BY MUNICIPALITIES, NOT INCLUD-
ING PROVIDERS  OF  TRANSPORTATION,  ON  ACCOUNT  OF  EARLY  INTERVENTION
SERVICES,  IN THE LAST COMPLETE STATE FISCAL YEAR FOR WHICH SUCH DATA IS
AVAILABLE.
  S 2. Subdivision 6 of section 2807-s  of  the  public  health  law  is
amended by adding two new paragraphs (g) and (h) to read as follows:
  (G)  A FURTHER GROSS STATEWIDE AMOUNT FOR TWO THOUSAND ELEVEN SHALL BE
ONE HUNDRED MILLION DOLLARS.
  (H) THE AMOUNT SPECIFIED IN PARAGRAPH (G) OF THIS SUBDIVISION SHALL BE
ALLOCATED AMONG THE MUNICIPALITIES BASED ON EACH MUNICIPALITY'S SHARE OF
EARLY INTERVENTION PROGRAM EXPENDITURES NOT REIMBURSABLE BY THE  MEDICAL
ASSISTANCE  PROGRAM  FOR  THE  LATEST TWELVE MONTH PERIOD FOR WHICH SUCH
DATA IS AVAILABLE.
  S 3. Subdivision 7 of section 2807-s  of  the  public  health  law  is
amended by adding a new paragraph (d) to read as follows:
  (D)  FUNDS  SHALL  BE ADDED TO THE FUNDS COLLECTED BY THE COMMISSIONER
FOR DISTRIBUTION IN ACCORDANCE WITH SECTION TWENTY-EIGHT HUNDRED SEVEN-O
OF THIS ARTICLE, IN THE FOLLOWING AMOUNT:  ONE HUNDRED  MILLION  DOLLARS
FOR THE PERIOD JANUARY FIRST, TWO THOUSAND ELEVEN THROUGH DECEMBER THIR-
TY-FIRST, TWO THOUSAND ELEVEN.
  S  4.  Subdivision  1  and  paragraphs (j) and (k) of subdivision 4 of
section 2557 of the public health  law,  subdivision  1  as  amended  by
section  4 of part C of chapter 1 of the laws of 2002 and paragraphs (j)
and (k) of subdivision 4 as amended by section 7 of part B3  of  chapter
62 of the laws of 2003, are 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 or, where the
services are covered by the medical assistance program, upon the  social
services  district of fiscal responsibility with respect to those eligi-
ble children who are also eligible for medical assistance. All  approved
costs  shall be paid 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. Notwithstanding the  insurance  law  or  regu-
lations 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  government benefit program under which an eligible child may
have coverage. [Nothing in this section shall increase or enhance cover-
ages provided for within an insurance contract subject to the provisions
of this title.]
  (j) The number of children that [have third party  reimbursement]  ARE
COVERED BY THE MEDICAL ASSISTANCE PROGRAM;
  (k) The number of claims submitted to [third party payors] THE MEDICAL
ASSISTANCE  PROGRAM  by municipality. The percentage of claims denied by
[third party payors] THE MEDICAL ASSISTANCE PROGRAM. The reasons for the
denials.

A. 4058--A                          3

  S 5. Subdivision 2 of section 2557 of the public health law, as  added
by chapter 428 of the laws of 1992, is amended to read as follows:
  2. The department shall reimburse the approved costs paid by a munici-
pality  for the purposes of this title, other than those reimbursable by
the medical assistance program [or by third party payors], in an  amount
of fifty percent of the amount expended in accordance with the rules and
regulations of the commissioner. Such state reimbursement to the munici-
pality  shall  not be paid prior to April first of the year in which the
approved costs are paid by the municipality.
  S 6. The section heading of section 2559 of the public health law,  as
added by chapter 428 of the laws of 1992, is amended to read as follows:
  [Third   party  insurance  and  medical]  MEDICAL  assistance  program
payments.
  S 7. Subdivision 3 of section 2559 of the public health law, as  added
by  chapter  428 of the laws of 1992, paragraph (a) as amended and para-
graph (d) as added by chapter 231 of the laws of  1993,  is  amended  to
read as follows:
  3.  (a)  Providers  of  early intervention services and transportation
services shall in the first instance and where applicable, seek  payment
from  [all  third  party  payors  including  governmental  agencies] THE
MEDICAL ASSISTANCE PROGRAM prior to claiming payment from a given  muni-
cipality  for services rendered to eligible children, provided that, for
the purpose of seeking payment from the medical assistance  program  [or
from  other  third  party  payors], the municipality shall be deemed the
provider of such early intervention services  to  the  extent  that  the
provider  has  promptly  furnished  to  the  municipality  adequate  and
complete information necessary to support the municipality billing,  and
provided further 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 policy] WHERE THE INSURED IS NOT ELIGI-
BLE FOR MEDICAL ASSISTANCE PURSUANT TO THE SOCIAL SERVICES LAW.
  (b) [The commissioner, in consultation with the director of budget and
the  superintendent of insurance, shall promulgate regulations providing
public reimbursement for deductibles and copayments  which  are  imposed
under an insurance policy or health benefit plan to the extent that such
deductibles   and   copayments  are  applicable  to  early  intervention
services.
  (c) Payments made for early intervention services under  an  insurance
policy  or  health  benefit  plan  which are provided as part of an IFSP
pursuant to section twenty-five hundred forty-five of this  title  shall
not  be applied by the insurer or plan administrator against any maximum
lifetime or annual limits specified in the  policy  or  health  benefits
plan,  pursuant to section eleven of the chapter of the laws of nineteen
hundred ninety-two which added this title.
  (d)] A municipality, or its designee,  shall  be  subrogated,  to  the
extent  of  the expenditures by such municipality 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 MEDICAL ASSISTANCE PROGRAM.  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].  NOTWITHSTANDING ANY INCONSISTENT PROVISION OF
THIS TITLE, EXCEPT AS PROVIDED FOR HEREIN, NO THIRD  PARTY  PAYOR  OTHER

A. 4058--A                          4

THAN  THE  MEDICAL ASSISTANCE PROGRAM SHALL BE REQUIRED TO REIMBURSE FOR
EARLY INTERVENTION SERVICES PROVIDED UNDER THIS TITLE.
  S  8.  This  act shall take effect January 1, 2011; provided, however,
that the amendments to section 2807-s of the public health law  made  by
sections  two  and  three of this act shall not affect the expiration of
such section and shall be deemed to expire therewith.

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Assembly Bill A4058A

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Archive: Last Bill Status - In Assembly Committee

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co-Sponsors

Richard Gottfried

Kevin Cahill

Ronald Canestrari

Barbara Clark

multi-Sponsors

Adriano Espaillat

David Koon

Alan Maisel

John McEneny

2009-A4058 - Details

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Richard Gottfried

Kevin Cahill

Ronald Canestrari

Barbara Clark

multi-Sponsors

Adriano Espaillat

David Koon

Alan Maisel

John McEneny

2009-A4058A (ACTIVE) - Details

2009-A4058A (ACTIVE) - Summary

2009-A4058A (ACTIVE) - Sponsor Memo

2009-A4058A (ACTIVE) - Bill Text download pdf

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