S T A T E O F N E W Y O R K
________________________________________________________________________
812
2011-2012 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 5, 2011
___________
Introduced by M. of A. PAULIN, GOTTFRIED, CAHILL, CANESTRARI, CLARK,
COOK, GALEF, GUNTHER, JACOBS, JAFFEE, LIFTON, MARKEY, MAYERSOHN, REIL-
LY, SCHROEDER, LAVINE, LATIMER, MAGNARELLI, DINOWITZ, PHEFFER, BENE-
DETTO -- Multi-Sponsored by -- M. of A. MAISEL, McENENY, MOLINARO,
SWEENEY, TOWNS, 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; to amend chapter 639 of the laws of 1996,
constituting the Health Care Reform Act of 1996 and chapter 1 of the
laws of 1999, constituting the New York Health Care Reform Act of
2000, in relation to extending provisions of such chapters relating
thereto
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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00329-02-1
A. 812 2
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-
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 TWELVE 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 TWELVE THROUGH DECEMBER THIR-
TY-FIRST, TWO THOUSAND TWELVE.
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
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[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-
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
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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. Subdivision 5 of section 168 of chapter 639 of the laws of 1996,
constituting the New York Health Care Reform Act of 1996, as amended by
section 1 of part B of chapter 58 of the laws of 2008, is amended to
read as follows:
5. sections 2807-c, 2807-j, 2807-s and 2807-t of the public health
law, as amended or as added by this act, shall expire on December 31,
[2011] 2014, and shall be thereafter effective only in respect to any
act done on or before such date or action or proceeding arising out of
such act including continued collections of funds from assessments and
allowances and surcharges established pursuant to sections 2807-c,
2807-j, 2807-s and 2807-t of the public health law, and administration
and distributions of funds from pools established pursuant to sections
2807-c, 2807-j, 2807-k, 2807-l, 2807-m, 2807-s and 2807-t of the public
health law related to patient services provided before December 31,
[2011] 2014, and continued expenditure of funds authorized for programs
and grants until the exhaustion of funds therefor;
S 9. Subdivision 1 of section 138 of chapter 1 of the laws of 1999,
constituting the New York Health Care Reform Act of 2000, as amended by
section 1-a of part B of chapter 58 of the laws of 2008, is amended to
read as follows:
1. sections 2807-c, 2807-j, 2807-s, and 2807-t of the public health
law, as amended by this act, shall expire on December 31, [2011] 2014,
and shall be thereafter effective only in respect to any act done before
such date or action or proceeding arising out of such act including
continued collections of funds from assessments and allowances and
surcharges established pursuant to sections 2807-c, 2807-j, 2807-s and
2807-t of the public health law, and administration and distributions of
funds from pools established pursuant to sections 2807-c, 2807-j,
2807-k, 2807-l, 2807-m, 2807-s, 2807-t, 2807-v and 2807-w of the public
health law, as amended or added by this act, related to patient services
provided before December 31, [2011] 2014, and continued expenditure of
funds authorized for programs and grants until the exhaustion of funds
therefor;
S 10. This act shall take effect immediately; provided, however, that
sections one through seven of this act shall take effect January 1,
2012; provided, further, 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.