senate Bill S4013C

Signed By Governor
2011-2012 Legislative Session

Facilitates payment of claims by health insurers to municipalities for early intervention services

download bill text pdf

Sponsored By

Archive: Last Bill Status Via A384 - Signed by Governor


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

do you support this bill?

Actions

view actions (16)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Aug 17, 2011 signed chap.406
Aug 05, 2011 delivered to governor
Jun 21, 2011 returned to assembly
passed senate
3rd reading cal.1463
substituted for s4013c
Jun 21, 2011 substituted by a384b
ordered to third reading cal.1463
committee discharged and committed to rules
Jun 15, 2011 print number 4013c
amend and recommit to insurance
Jun 13, 2011 print number 4013b
amend and recommit to insurance
Jun 10, 2011 print number 4013a
amend (t) and recommit to insurance
Mar 14, 2011 referred to insurance

Votes

view votes

Bill Amendments

Original
A
B
C (Active)
Original
A
B
C (Active)

S4013 - Bill Details

See Assembly Version of this Bill:
A384B
Law Section:
Insurance Law
Laws Affected:
Amd §3235-a, Ins L; amd §2559, Pub Health L
Versions Introduced in Previous Legislative Sessions:
2011-2012: A384A
2009-2010: A3719

S4013 - Bill Texts

view summary

Facilitates payment of claims by health insurers to municipalities for early intervention services.

view sponsor memo
BILL NUMBER:S4013

TITLE OF BILL:
An act
to amend the insurance law, in relation to coverage of early
intervention services

PURPOSE OR GENERAL IDEA OF BILL:
To amend the insurance law to ensure
recoupment from commercial insurers for the cost of the Early
Intervention program.

SUMMARY OF SPECIFIC PROVISIONS:
Section one amends Section 3235-a of
the insurance law, as added by section 3 of part C of chapter 1 of
the laws of 2002, to prohibit accident and health insurance policies
from excluding from coverage services provided under title two-A of
article twenty-five of the public health law. Section one amends
paragraph (c) of section 3235-a to require that the insurer provide a
municipality with information on the extent of benefits available to
an insured under the policy upon the insurer's receipt of written
notice from the municipality as to its subrogation rights. The
section also amends paragraph (d) of Section 3235-a to provide that
the individualized family services plan, upon certification by the
early intervention official, be deemed to meet any precertification,
preauthorization and medical necessity requirements imposed on
benefits under the policy. Further, section one adds: paragraph (e)
to prohibit insurers from denying claims based on the location where
services are provided. the duration of the child's condition or that
the child's condition is not likely to improve within a time
specified in the policy, the absence of a referral by a primary care
provider, or that the provider is a non-participating
or non-network provider; subsection (f) to provide that
the time of loss for the purposes of filing claims shall be the date
of payment to the contractor by the municipality; and subsection (g)
to require the insurer to issue payment in the amount of the approved
costs for early intervention services.

Section two provides the effective date.

JUSTIFICATION:
Despite Article 25 of the federal Individuals with
Disabilities Education Act (IDEA) which mandates public and private
commercial insurance to be maximized in financing early intervention
(EI) services, reimbursement from third party payers, other than
Medicaid, have been minimal leaving the cost of this entitlement to
be paid by state and municipal tax dollars.

In recognition of the need to improve recoupment of insurance monies
to help pay for EI, the Third Party Reimbursement Task Force of the
New York State Early Invention coordinating council was convened in
1999.

That Task Force examined data on billing and recoupment in 1997 and
found that private insurance collection was at a low rate of 9%. An
updated survey conducted by the New York State Association of County


Health Officials of billing and recoupment in 2000 found that, while
the amount billed to insurers had almost doubled, the recoupment rate
remained a low 11%.

The Task Force also consulted with experts from Massachusetts, Indiana
and Virginia, all states that have included in state law the specific
requirements necessary to ensure insurance payments for EI. Experts
from these three states indicated that requiring insurers to pay for
El services minimally impacted insurance premiums and that insurers
may in fact have saved money in the long run due to the therapeutic
interventions under EI. Experts from the three states confirmed the
Task Force's finding that the single most important factor to improve
collections as well as reducing administrative burdens was
legislation requiring private commercial insurers to pay for EI.

Current insurance law does not include the necessary language to
insure that payments are made nor does the language preclude the
majority of reasons given for ET denials. As a result, it is
necessary that specific language be adopted to fix this problem.

PRIOR LEGISLATIVE HISTORY:
A.3719, 2009 and 2010 referred to
insurance. A.4399, 2007 and 2008 referred to insurance, A.1014-A,
2005 and 2006 referred to insurance. Same as S.4365-A, 2005 and 2006
referred to insurance. A.6760-A, 2003 and 2004 referred to insurance.
Same as S.2410-A 2003 and 2004 referred to insurance. A.11436, 2002
referred to insurance.

New Bill in the Senate

FISCAL IMPLICATIONS:
None to the state, savings for municipalities.

EFFECTIVE DATE:
This act shall take effect immediately.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  4013

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 14, 2011
                               ___________

Introduced  by Sen. McDONALD -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law, in  relation  to  coverage  of  early
  intervention services

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

  Section 1. Section 3235-a of the insurance law, as added by section  3
of  part  C  of  chapter  1  of  the laws of 2002, is amended to read as
follows:
  S 3235-a. Payment for early intervention services. (a)  No  policy  of
accident  and  health  insurance, including contracts issued pursuant to
article forty-three of this chapter, shall exclude coverage  for  other-
wise  covered services [solely on the basis that the services constitute
early intervention program services] THAT ARE PROVIDED under title two-A
of article twenty-five of the public health law.
  (b) Where a policy of  accident  and  health  insurance,  including  a
contract  issued  pursuant  to  article  forty-three  of  this  chapter,
provides coverage for an early intervention program service, such cover-
age shall not be applied against any maximum annual or lifetime monetary
limits set forth in such policy or contract. Visit limitations and other
terms and conditions of the policy  will  continue  to  apply  to  early
intervention  services.  However, any visits used for early intervention
program services shall not reduce the number of visits otherwise  avail-
able under the policy or contract for such services.
  (c) Any right of subrogation to benefits which a municipality is enti-
tled  in  accordance  with paragraph (d) of subdivision three of section
twenty-five hundred fifty-nine of the public health law shall  be  valid
and  enforceable to the extent benefits are available under any accident
and health insurance policy. The right of subrogation does not attach to
insurance benefits paid or provided under any accident and health insur-
ance policy prior to receipt by the insurer of written notice  from  the

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00328-01-1

S. 4013                             2

municipality.  UPON  THE  INSURER'S  RECEIPT  OF WRITTEN NOTICE FROM THE
MUNICIPALITY, THE INSURER SHALL PROVIDE THE MUNICIPALITY  WITH  INFORMA-
TION ON THE EXTENT OF BENEFITS AVAILABLE TO AN INSURED UNDER THE POLICY.
  (d) THE INDIVIDUALIZED FAMILY SERVICES PLAN, UPON CERTIFICATION BY THE
EARLY  INTERVENTION  OFFICIAL, AS DEFINED IN SECTION TWENTY-FIVE HUNDRED
FORTY-ONE OF THE PUBLIC HEALTH LAW, OR SUCH OFFICIAL'S  DESIGNEE,  SHALL
BE  DEEMED  TO  MEET ANY PRECERTIFICATION, PREAUTHORIZATION, AND MEDICAL
NECESSITY REQUIREMENTS IMPOSED ON BENEFITS UNDER THE POLICY.
  (E) NO INSURER, INCLUDING A HEALTH MAINTENANCE ORGANIZATION  ISSUED  A
CERTIFICATE  OF  AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW AND A CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THIS  CHAP-
TER,  SHALL  DENY  PAYMENT  OF  AN EARLY INTERVENTION CLAIM BASED ON THE
FOLLOWING:
  (1) THE LOCATION WHERE SERVICES ARE PROVIDED;
  (2) THE DURATION OF THE CHILD'S  CONDITION  AND/OR  THAT  THE  CHILD'S
CONDITION  IS  NOT  AMENABLE TO SIGNIFICANT IMPROVEMENT WITHIN A CERTAIN
PERIOD OF TIME AS SPECIFIED IN THE POLICY;
  (3) THE ABSENCE OF A PRIMARY CARE PROVIDER REFERRAL; OR
  (4) THAT THE PROVIDER OF SERVICES IS NOT A  NETWORK  OR  PARTICIPATING
PROVIDER.
   (F)  TIME OF LOSS FOR THE PURPOSES OF FILING CLAIMS SHALL BE THE DATE
OF CONTRACTOR PAYMENT BY THE MUNICIPALITY.
  (G) THE INSURER SHALL  ISSUE  PAYMENT  IN  THE  AMOUNT  EQUAL  TO  THE
APPROVED COSTS FOR EARLY INTERVENTION SERVICES.
  (H)  No  insurer, including a health maintenance organization issued a
certificate of authority under article forty-four of the  public  health
law  and a corporation organized under article forty-three of this chap-
ter, shall refuse to issue an accident and health  insurance  policy  or
contract  or  refuse to renew an accident and health insurance policy or
contract solely because the applicant or insured is  receiving  services
under the early intervention program.
  S 2. This act shall take effect immediately.

S4013A - Bill Details

See Assembly Version of this Bill:
A384B
Law Section:
Insurance Law
Laws Affected:
Amd §3235-a, Ins L; amd §2559, Pub Health L
Versions Introduced in Previous Legislative Sessions:
2011-2012: A384A
2009-2010: A3719

S4013A - Bill Texts

view summary

Facilitates payment of claims by health insurers to municipalities for early intervention services.

view sponsor memo
BILL NUMBER:S4013A

TITLE OF BILL:
An act
to amend the insurance law and the public health law,
in relation to coverage of early
intervention services

PURPOSE OR GENERAL IDEA OF BILL:
To amend the insurance law to ensure recoupment from commercial
insurers for the cost of the Early Intervention program.

SUMMARY OF SPECIFIC PROVISIONS:
Section one amends Section 3235-a of the insurance law, as added by
section 3 of part C of chapter 1 of the laws of 2002, to prohibit
accident and health insurance policies from excluding from coverage
services provided under title two-A of article twenty-five of the
public health law.
Section one amends paragraph (c) of section 3235-a to require that the
insurer provide a municipality with information on the extent of
benefits available to an insured under the policy upon the insurer's
receipt of written notice from the municipality as to its subrogation
rights. The section also amends paragraph (d) of Section 3235-a to
provide that the individualized family services plan, upon
certification by the early intervention official, be deemed to meet
any precertification, preauthorization and medical necessity
requirements imposed on benefits under the policy. Further, section
one adds: paragraph (e) to prohibit insurers from denying claims
based on the location where services are provided. the duration of
the child's condition or that the child's condition is not likely to
improve within a time specified in the policy, the absence of a
referral by a primary care provider, or that the provider is a
non-participating or non-network provider; subsection (f) to provide
that the time of loss for the purposes of filing claims shall be the
date of payment to the contractor by the municipality; and subsection
(g) to require the insurer to issue payment in the amount of the
approved costs for early intervention services.

Section two provides the effective date.

JUSTIFICATION:
Despite Article 25 of the federal Individuals with Disabilities
Education Act (IDEA) which mandates public and private commercial
insurance to be maximized in financing early intervention (EI)
services, reimbursement from third party payers, other than Medicaid,
have been minimal leaving the cost of this entitlement to be paid by
state and municipal tax dollars.

In recognition of the need to improve recoupment of insurance monies
to help pay for EI, the Third Party Reimbursement Task Force of the
New York State Early Invention coordinating council was convened in
1999.

That Task Force examined data on billing and recoupment in 1997 and
found that private insurance collection was at a low rate of 9%. An
updated survey conducted by the New York State Association of County


Health Officials of billing and recoupment in 2000 found that, while
the amount billed to insurers had almost doubled, the recoupment rate
remained a low 11%.

The Task Force also consulted with experts from Massachusetts, Indiana
and Virginia, all states that have included in state law the specific
requirements necessary to ensure insurance payments for EI. Experts
from these three states indicated that requiring insurers to pay for
El services minimally impacted insurance premiums and that insurers
may in fact have saved money in the long run due to the therapeutic
interventions under EI. Experts from the three states confirmed the
Task Force's finding that the single most important factor to improve
collections as well as reducing administrative burdens was
legislation requiring private commercial insurers to pay for EI.

Current insurance law does not include the necessary language to
insure that payments are made nor does the language preclude the
majority of reasons given for ET denials. As a result, it is
necessary that specific language be adopted to fix this problem.

PRIOR LEGISLATIVE HISTORY:
A.3719, 2009 and 2010 referred to insurance. A.4399, 2007 and 2008
referred to insurance, A.1014-A, 2005 and 2006 referred to insurance.
Same as S.4365-A, 2005 and 2006 referred to insurance. A.6760-A, 2003
and 2004 referred to insurance.
Same as S.241O-A 2003 and 2004 referred to insurance. A.11436, 2002
referred to insurance.

New Bill in the Senate

FISCAL IMPLICATIONS:
None to the state, savings for municipalities.

EFFECTIVE DATE:
This act shall take effect immediately.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4013--A

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 14, 2011
                               ___________

Introduced  by Sen. McDONALD -- read twice and ordered printed, and when
  printed to be committed to the Committee  on  Insurance  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to coverage of early intervention services

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

  Section 1. Subsection (c) of section 3235-a of the insurance  law,  as
added  by  section  3  of  part  C  of chapter 1 of the laws of 2002, is
amended and a new subsection (e) is added to read as follows:
  (c) Any right of subrogation to benefits which a municipality is enti-
tled in accordance with paragraph (d) of subdivision  three  of  section
twenty-five  hundred  fifty-nine of the public health law shall be valid
and enforceable to the extent benefits are available under any  accident
and health insurance policy. The right of subrogation does not attach to
insurance benefits paid or provided under any accident and health insur-
ance  policy  prior to receipt by the insurer of written notice from the
municipality. UPON THE INSURER'S RECEIPT OF WRITTEN REQUEST  AND  NOTICE
FROM THE MUNICIPALITY THAT SUCH RIGHT OF SUBROGATION HAS BEEN GRANTED TO
SUCH  MUNICIPALITY,  THE  INSURER  SHALL  PROVIDE  THE MUNICIPALITY WITH
INFORMATION ON THE EXTENT OF BENEFITS AVAILABLE TO  THE  COVERED  PERSON
UNDER SUCH POLICY.
  (E)  WRITTEN  CLAIM  FOR  EARLY INTERVENTION PROGRAM SERVICES SHALL BE
SUBMITTED BY THE  MUNICIPALITY  AS  THE  APPROVED  PROVIDER  WITHIN  ONE
HUNDRED FIFTY DAYS FROM THE DATE OF SERVICE.
  S  2.    Paragraph  (a) of subdivision 3 of section 2559 of the public
health law is amended by adding two new subparagraphs (i)  and  (ii)  to
read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00328-07-1

S. 4013--A                          2

  (I)  PARENTS  SHALL PROVIDE AND THE MUNICIPALITY SHALL OBTAIN INFORMA-
TION ON ANY PLAN OF INSURANCE UNDER WHICH AN ELIGIBLE CHILD  HAS  COVER-
AGE.
  (II)  PARENTS  SHALL  PROVIDE THE MUNICIPALITY WITH A WRITTEN REFERRAL
FROM A PRIMARY CARE PROVIDER AS DOCUMENTATION, FOR ELIGIBLE CHILDREN, OF
THE MEDICAL NECESSITY OF EARLY INTERVENTION SERVICES.
  S 3. This act shall take effect immediately.

S4013B - Bill Details

See Assembly Version of this Bill:
A384B
Law Section:
Insurance Law
Laws Affected:
Amd §3235-a, Ins L; amd §2559, Pub Health L
Versions Introduced in Previous Legislative Sessions:
2011-2012: A384A
2009-2010: A3719

S4013B - Bill Texts

view summary

Facilitates payment of claims by health insurers to municipalities for early intervention services.

view sponsor memo
BILL NUMBER:S4013B

TITLE OF BILL:
An act
to amend the insurance law and the public health law,
in relation to coverage of early
intervention services

PURPOSE OR GENERAL IDEA OF BILL:
To amend the insurance law to ensure recoupment from commercial
insurers for the cost of the Early Intervention program.

SUMMARY OF SPECIFIC PROVISIONS:
Section one amends Section 3235-a of the insurance law, as added by
section 3 of part C of chapter 1 of the laws of 2002, to prohibit
accident and health insurance policies from excluding from coverage
services provided under title two-A of article twenty-five of the
public health law.
Section one amends paragraph (c) of section 3235-a to require that the
insurer provide a municipality with information on the extent of
benefits available to an insured under the policy upon the insurer's
receipt of written notice from the municipality as to its subrogation
rights. The section also amends paragraph (d) of Section 3235-a to
provide that the individualized family services plan, upon
certification by the early intervention official, be deemed to meet
any precertification, preauthorization and medical necessity
requirements imposed on benefits under the policy. Further, section
one adds: paragraph (e) to prohibit insurers from denying claims
based on the location where services are provided. the duration of
the child's condition or that the child's condition is not likely to
improve within a time specified in the policy, the absence of a
referral by a primary care provider, or that the provider is a
non-participating or non-network provider; subsection (f) to provide
that the time of loss for the purposes of filing claims shall be the
date of payment to the contractor by the municipality; and subsection
(g) to require the insurer to issue payment in the amount of the
approved costs for early intervention services.

Section two adds two new subparagraphs to section 2559 of the public
health law.

Section three provides the effective date.

JUSTIFICATION:
Despite Article 25 of the federal Individuals with Disabilities
Education Act (IDEA) which mandates public and private commercial
insurance to be maximized in financing early intervention (EI)
services, reimbursement from third party payers, other than Medicaid,
have been minimal leaving the cost of this entitlement to be paid by
state and municipal tax dollars.

In recognition of the need to improve recoupment of insurance monies
to help pay for EI, the Third Party Reimbursement Task Force of the
New York State Early Invention coordinating council was convened in
1999.


That Task Force examined data on billing and recoupment in 1997 and
found that private insurance collection was at a low rate of 9%. An
updated survey conducted by the New York State Association of County
Health Officials of billing and recoupment in 2000 found that, while
the amount billed to insurers had almost doubled, the recoupment rate
remained a low 11%.

The Task Force also consulted with experts from Massachusetts, Indiana
and Virginia, all states that have included in state law the specific
requirements necessary to ensure insurance payments for EI. Experts
from these three states indicated that requiring insurers to pay for
El services minimally impacted insurance premiums and that insurers
may in fact have saved money in the long run due to the therapeutic
interventions under EI. Experts from the three states confirmed the
Task Force's finding that the single most important factor to improve
collections as well as reducing administrative burdens was
legislation requiring private commercial insurers to pay for EI.

Current insurance law does not include the necessary language to
insure that payments are made nor does the language preclude the
majority of reasons given for ET denials. As a result, it is
necessary that specific language be adopted to fix this problem.

PRIOR LEGISLATIVE HISTORY:
A.3719, 2009 and 2010 referred to insurance. A.4399, 2007 and 2008
referred to insurance, A.1014-A, 2005 and 2006 referred to insurance.
Same as S.4365-A, 2005 and 2006 referred to insurance. A.6760-A, 2003
and 2004 referred to insurance.
Same as S.241O-A 2003 and 2004 referred to insurance. A.11436, 2002
referred to insurance.

New Bill in the Senate

FISCAL IMPLICATIONS:
None to the state, savings for municipalities.

EFFECTIVE DATE:
This act shall take effect immediately.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4013--B

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 14, 2011
                               ___________

Introduced  by Sen. McDONALD -- read twice and ordered printed, and when
  printed to be committed to the Committee  on  Insurance  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to  said  committee  --  committee  discharged,  bill amended, ordered
  reprinted as amended and recommitted to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to coverage of early intervention services

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

  Section  1.  Subsection (c) of section 3235-a of the insurance law, as
added by section 3 of part C of chapter  1  of  the  laws  of  2002,  is
amended and a new subsection (e) is added to read as follows:
  (c) Any right of subrogation to benefits which a municipality is enti-
tled  in  accordance  with paragraph (d) of subdivision three of section
twenty-five hundred fifty-nine of the public health law shall  be  valid
and  enforceable to the extent benefits are available under any accident
and health insurance policy. The right of subrogation does not attach to
insurance benefits paid or provided under any accident and health insur-
ance policy prior to receipt by the insurer of written notice  from  the
municipality.  UPON  THE INSURER'S RECEIPT OF WRITTEN REQUEST AND NOTICE
FROM THE MUNICIPALITY THAT SUCH RIGHT OF SUBROGATION HAS BEEN GRANTED TO
SUCH MUNICIPALITY AND THAT THE COVERED PERSON HAS AUTHORIZED THE RELEASE
OF INFORMATION TO THE MUNICIPALITY, THE INSURER SHALL PROVIDE THE  MUNI-
CIPALITY  WITH  INFORMATION  ON  THE EXTENT OF BENEFITS AVAILABLE TO THE
COVERED PERSON UNDER SUCH POLICY.
  (E) WRITTEN CLAIM FOR EARLY INTERVENTION  PROGRAM  SERVICES  SHALL  BE
SUBMITTED  BY  THE  MUNICIPALITY  AS  THE  APPROVED  PROVIDER WITHIN ONE
HUNDRED FIFTY DAYS FROM THE DATE OF SERVICE.
  S 2.  Paragraph (a) of subdivision 3 of section  2559  of  the  public
health  law  is  amended by adding two new subparagraphs (i) and (ii) to
read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00328-10-1

S. 4013--B                          2

  (I) PARENTS SHALL PROVIDE AND THE MUNICIPALITY SHALL  OBTAIN  INFORMA-
TION  ON  ANY PLAN OF INSURANCE UNDER WHICH AN ELIGIBLE CHILD HAS COVER-
AGE.
  (II)  PARENTS  SHALL  PROVIDE THE MUNICIPALITY WITH A WRITTEN REFERRAL
FROM A PRIMARY CARE PROVIDER AS DOCUMENTATION, FOR ELIGIBLE CHILDREN, OF
THE MEDICAL NECESSITY OF EARLY INTERVENTION SERVICES.
  S 3. This act shall take effect immediately.

Co-Sponsors

S4013C (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A384B
Law Section:
Insurance Law
Laws Affected:
Amd §3235-a, Ins L; amd §2559, Pub Health L
Versions Introduced in Previous Legislative Sessions:
2011-2012: A384A
2009-2010: A3719

S4013C (ACTIVE) - Bill Texts

view summary

Facilitates payment of claims by health insurers to municipalities for early intervention services.

view sponsor memo
BILL NUMBER:S4013C

TITLE OF BILL:
An act
to amend the insurance law and the public health law,
in relation to coverage of early
intervention services

PURPOSE OR GENERAL IDEA OF BILL:
To amend the insurance law to ensure recoupment from commercial
insurers for the cost of the Early Intervention program.

SUMMARY OF SPECIFIC PROVISIONS:
Section one amends Section 3235-a of the insurance law, as added by
section 3 of part C of chapter 1 of the laws of 2002, to prohibit
accident and health insurance policies from excluding from coverage
services provided under title two-A of article twenty-five of the
public health law.
Section one amends paragraph (c) of section 3235-a to require that the
insurer provide a municipality with information on the extent of
benefits available to an insured under the policy upon the insurer's
receipt of written notice from the municipality as to its subrogation
rights. The section also amends paragraph (d) of Section 3235-a to
provide that the individualized family services plan, upon
certification by the early intervention official, be deemed to meet
any precertification, preauthorization and medical necessity
requirements imposed on benefits under the policy. Further, section
one adds: paragraph (e) to prohibit insurers from denying claims
based on the location where services are provided. the duration of
the child's condition or that the child's condition is not likely to
improve within a time specified in the policy, the absence of a
referral by a primary care provider, or that the provider is a
non-participating or non-network provider; subsection (f) to provide
that the time of loss for the purposes of filing claims shall be the
date of payment to the contractor by the municipality; and subsection
(g) to require the insurer to issue payment in the amount of the
approved costs for early intervention services.

Section two adds two new subparagraphs to section 2559 of the public
health law.

Section three provides the effective date.

JUSTIFICATION:
Despite Article 25 of the federal Individuals with Disabilities
Education Act (IDEA) which mandates public and private commercial
insurance to be maximized in financing early intervention (EI)
services, reimbursement from third party payers, other than Medicaid,
have been minimal leaving the cost of this entitlement to be paid by
state and municipal tax dollars.

In recognition of the need to improve recoupment of insurance monies
to help pay for EI, the Third Party Reimbursement Task Force of the
New York State Early Invention coordinating council was convened in
1999.


That Task Force examined data on billing and recoupment in 1997 and
found that private insurance collection was at a low rate of 9%. An
updated survey conducted by the New York State Association of County
Health Officials of billing and recoupment in 2000 found that, while
the amount billed to insurers had almost doubled, the recoupment rate
remained a low 11%.

The Task Force also consulted with experts from Massachusetts, Indiana
and Virginia, all states that have included in state law the specific
requirements necessary to ensure insurance payments for EI. Experts
from these three states indicated that requiring insurers to pay for
El services minimally impacted insurance premiums and that insurers
may in fact have saved money in the long run due to the therapeutic
interventions under EI. Experts from the three states confirmed the
Task Force's finding that the single most important factor to improve
collections as well as reducing administrative burdens was
legislation requiring private commercial insurers to pay for EI.

Current insurance law does not include the necessary language to
insure that payments are made nor does the language preclude the
majority of reasons given for ET denials. As a result, it is
necessary that specific language be adopted to fix this problem.

PRIOR LEGISLATIVE HISTORY:
A.3719, 2009 and 2010 referred to insurance. A.4399, 2007 and 2008
referred to insurance, A.1014-A, 2005 and 2006 referred to insurance.
Same as S.4365-A, 2005 and 2006 referred to insurance. A.6760-A, 2003
and 2004 referred to insurance.
Same as S.2410-A 2003 and 2004 referred to insurance. A.11436, 2002
referred to insurance.

New Bill in the Senate

FISCAL IMPLICATIONS:
None to the state, savings for municipalities.

EFFECTIVE DATE:
This act shall take effect immediately.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4013--C

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 14, 2011
                               ___________

Introduced  by Sen. McDONALD -- read twice and ordered printed, and when
  printed to be committed to the Committee  on  Insurance  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to  said  committee  --  committee  discharged,  bill amended, ordered
  reprinted as amended and recommitted to said  committee  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to coverage of early intervention services

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

  Section 1. Subsection (c) of section 3235-a of the insurance  law,  as
added  by  section  3  of  part  C  of chapter 1 of the laws of 2002, is
amended and a new subsection (e) is added to read as follows:
  (c) Any right of subrogation to benefits which a municipality is enti-
tled in accordance with paragraph (d) of subdivision  three  of  section
twenty-five  hundred  fifty-nine of the public health law shall be valid
and enforceable to the extent benefits are available under any  accident
and health insurance policy. The right of subrogation does not attach to
insurance benefits paid or provided under any accident and health insur-
ance  policy  prior to receipt by the insurer of written notice from the
municipality. UPON THE INSURER'S RECEIPT OF WRITTEN REQUEST  AND  NOTICE
FROM THE MUNICIPALITY THAT SUCH RIGHT OF SUBROGATION HAS BEEN GRANTED TO
SUCH  MUNICIPALITY  AND  THAT  THE INSURED HAS AUTHORIZED THE RELEASE OF
INFORMATION TO THE MUNICIPALITY, THE INSURER SHALL PROVIDE  THE  MUNICI-
PALITY  WITH  INFORMATION  ON  THE  EXTENT  OF BENEFITS AVAILABLE TO THE
COVERED PERSON UNDER SUCH POLICY.
  (E) WRITTEN CLAIM FOR EARLY INTERVENTION  PROGRAM  SERVICES  SHALL  BE
SUBMITTED  BY  THE  MUNICIPALITY  AS  THE  APPROVED  PROVIDER WITHIN ONE
HUNDRED FIFTY DAYS FROM THE DATE OF SERVICE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00328-12-1

S. 4013--C                          2

  S 2.  Paragraph (a) of subdivision 3 of section  2559  of  the  public
health  law  is  amended by adding two new subparagraphs (i) and (ii) to
read as follows:
  (I)  PARENTS  SHALL PROVIDE AND THE MUNICIPALITY SHALL OBTAIN INFORMA-
TION ON ANY PLAN OF INSURANCE UNDER WHICH AN ELIGIBLE CHILD  HAS  COVER-
AGE.
  (II)  PARENTS  SHALL  PROVIDE THE MUNICIPALITY WITH A WRITTEN REFERRAL
FROM A PRIMARY CARE PROVIDER AS DOCUMENTATION, FOR ELIGIBLE CHILDREN, OF
THE MEDICAL NECESSITY OF EARLY INTERVENTION SERVICES.
  S 3. This act shall take effect immediately.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.