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

                                 6517--A

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              April 4, 2013
                               ___________

Introduced  by  M.  of A. PAULIN, GOTTFRIED, CAHILL, CLARK, COOK, GALEF,
  GUNTHER, JACOBS, JAFFEE, LIFTON, MARKEY, LAVINE, MAGNARELLI, DINOWITZ,
  BENEDETTO -- Multi-Sponsored by -- M. of  A.  SWEENEY,  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
GRANTS  SHALL  BE  DEEMED  REIMBURSEMENT FROM THIRD PARTY PAYORS TO SUCH
MUNICIPALITIES AND THE STATE OF NEW YORK FOR THE PURPOSES OF  THE  EARLY
INTERVENTION PROGRAM.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03039-03-4
              

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  (B)  GRANTS  UNDER THIS SUBDIVISION SHALL BE AWARDED TO MUNICIPALITIES
BY THE COMMISSIONER. EACH MUNICIPALITY AND THE STATE OF NEW  YORK  SHALL
RECEIVE  A  SHARE OF SUCH GRANTS EQUAL TO ITS PROPORTIONATE SHARE OF THE
TOTAL APPROVED STATEWIDE DOLLARS NOT REIMBURSABLE BY THE MEDICAL ASSIST-
ANCE  PROGRAM  PAID  TO  PROVIDERS OF EARLY INTERVENTION SERVICES BY THE
STATE AND MUNICIPALITIES 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 FIFTEEN SHALL BE
ONE HUNDRED FIFTEEN MILLION DOLLARS.
  (H) THE AMOUNT SPECIFIED IN PARAGRAPH (G) OF THIS SUBDIVISION SHALL BE
ALLOCATED AMONG THE MUNICIPALITIES AND THE STATE OF NEW  YORK  BASED  ON
EACH  MUNICIPALITY'S  SHARE  AND THE STATE'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 FIFTEEN MILLION
DOLLARS FOR THE PERIOD  JANUARY  FIRST,  TWO  THOUSAND  FIFTEEN  THROUGH
DECEMBER THIRTY-FIRST, TWO THOUSAND FIFTEEN.
  S  4.  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 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.]
  S 5. Section 2557 of the public health law is amended by adding a  new
subdivision 4 to read as follows:
  4.  THE COMMISSIONER SHALL COLLECT DATA, BY MUNICIPALITY, ON THE EARLY
INTERVENTION PROGRAM AUTHORIZED UNDER THIS TITLE FOR PURPOSES OF IMPROV-
ING THE EFFICIENCY, COST EFFECTIVENESS, AND  QUALITY  OF  SUCH  PROGRAM.
SUCH MUNICIPALITY DATA COLLECTION SHALL INCLUDE BUT NOT BE LIMITED TO:
  (A) THE NUMBER AND AGES OF CHILDREN ENROLLED IN THE EARLY INTERVENTION
PROGRAM;
  (B)  THE  TOTAL NUMBER OF CHILDREN, WITHIN A MUNICIPALITY, RECEIVING A
SINGLE SERVICE, THE PERCENTAGE OF THOSE CHILDREN BY  SERVICE  TYPE,  AND
THE AVERAGE FREQUENCY OF VISITS PER WEEK FOR SUCH SERVICE TYPE;

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  (C)  THE  TOTAL  NUMBER  OF CHILDREN, WITHIN A MUNICIPALITY, RECEIVING
MULTIPLE SERVICES, THE PERCENTAGE OF THOSE CHILDREN BY SERVICE TYPE, THE
AVERAGE FREQUENCY OF VISITS PER WEEK FOR SUCH SERVICE TYPE AND THE AVER-
AGE NUMBER OF SERVICE TYPES THAT EACH CHILD RECEIVES;
  (D)  THE  NUMBER OF NEW YORK STATE APPROVED AGENCIES, INSTITUTIONS, OR
ORGANIZATIONS PROVIDING EARLY INTERVENTION SERVICES BY SERVICE SPECIALTY
OR SPECIALTIES AND THE NUMBER OF NEW  YORK  STATE  APPROVED  INDEPENDENT
PROVIDERS  OF  EARLY  INTERVENTION  SERVICES  BY  SERVICE  SPECIALTY  OR
SPECIALTIES;
  (E) THE NUMBER AND PERCENTAGE OF CHILDREN RECEIVING A  SINGLE  SERVICE
BY  TYPE OF NEW YORK STATE APPROVED SERVICE PROVIDER, AND THE NUMBER AND
PERCENTAGE OF CHILDREN RECEIVING MULTIPLE SERVICES BY TYPE OF  NEW  YORK
STATE APPROVED SERVICE PROVIDER;
  (F)  THE  OVERALL  NUMBER  OF  NEW YORK STATE APPROVED EVALUATORS. THE
NUMBER OF APPROVED EVALUATORS WHO ALSO PROVIDE SERVICES TO EARLY  INTER-
VENTION CHILDREN THEY HAVE EVALUATED;
  (G)  THE  NUMBER OF FAMILIES RECEIVING FAMILY SUPPORTIVE SERVICES SUCH
AS FAMILY TRAINING, COUNSELING, PARENT SUPPORT GROUPS, AND RESPITE;
  (H) THE TYPES OF CLINICAL PRACTICE GUIDELINES,  EVALUATION  TOOLS  AND
TESTING  INSTRUMENTS  USED BY MUNICIPALITIES TO ESTABLISH ELIGIBILITY OR
NEED FOR EARLY INTERVENTION SERVICES;
  (I) BOTH SERVICE, COST AND PAYMENT OVERSIGHT MECHANISMS USED BY  COUN-
TIES  TO  ENSURE  QUALITY  AND  EFFICIENT DELIVERY OF EARLY INTERVENTION
SERVICES;
  (J) THE NUMBER OF CHILDREN THAT ARE COVERED BY THE MEDICAL  ASSISTANCE
PROGRAM;
  (K)  THE  NUMBER OF CLAIMS SUBMITTED TO THE MEDICAL ASSISTANCE PROGRAM
BY MUNICIPALITY. THE PERCENTAGE OF CLAIMS DENIED BY THE MEDICAL  ASSIST-
ANCE PROGRAM. THE REASONS FOR THE DENIALS.
  THE  COMMISSIONER  SHALL  COLLECT  AND  ANALYZE  SUCH DATA ELEMENTS TO
DETERMINE SERVICE AND UTILIZATION PATTERNS AND TO  ENHANCE  THE  DEPART-
MENT'S ONGOING PROVISION OF PROGRAM OVERSIGHT AND GUIDANCE. IN ADDITION,
THE  COMMISSIONER  SHALL  REPORT FOR THE PERIOD JULY FIRST, TWO THOUSAND
FIFTEEN TO DECEMBER THIRTY-FIRST, TWO THOUSAND  FIFTEEN,  AND  FOR  EACH
CALENDAR  YEAR THEREAFTER, TO THE GOVERNOR AND THE LEGISLATURE, BY MARCH
FIRST OF EACH YEAR, THE INFORMATION AND ANALYSIS REQUIRED BY THIS SUBDI-
VISION.
  S 6. Subdivision 2 of section  2557  of  the  public  health  law,  as
amended  by  section 9-a of part A of chapter 56 of the laws of 2012, 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;  provided,  however,  that  in   the
discretion  of  the  department and with the approval of the director of
the division of the budget, the department may reimburse  municipalities
in  an  amount  greater  than fifty percent of the amount expended. Such
state reimbursement to the municipality shall not be paid prior to April
first of the year in which the approved costs are paid  by  the  munici-
pality,  provided, however that, subject to the approval of the director
of the budget, the department may pay such state  aid  reimbursement  to
the municipality prior to such date.
  S  7. 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:

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  [Third  party  insurance  and  medical]  MEDICAL  assistance   program
payments.
  S 8.  Subdivision 3 of section 2559 of the public health law, as added
by  chapter  428  of  the  laws  of 1992, paragraphs (a), (c) and (d) as
amended by section 11 of part A of chapter 56 of the laws  of  2012  and
paragraph  (b) as further amended by section 104 of part A of chapter 62
of the laws of 2011, is amended to read as follows:
  3. (a) Providers of evaluations and early intervention services, here-
inafter collectively referred to in this subdivision  as  "provider"  or
"providers",  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
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] WHERE THE INSURED IS NOT ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO
THE SOCIAL SERVICES LAW.
  (i)  Parents  shall  provide  the municipality and service coordinator
information on any insurance policy, plan or  contract  under  which  an
eligible child has coverage.
  (ii)  Parents shall provide the municipality and the service coordina-
tor with a written referral from a primary care provider  as  documenta-
tion,  for  eligible  children, of the medical necessity of early inter-
vention services.
  (iii) providers shall utilize the department's fiscal agent  and  data
system  for claiming payment for evaluations and services rendered under
the early intervention program.
  (b) [The commissioner, in consultation with the director of budget and
the superintendent of financial services, 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 inter-
vention services.
  (c) Payments made for early intervention services under  an  insurance
policy  or  health  benefit plan, including payments made by the medical
assistance program or other governmental third party  payor,  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, and a provider shall be subro-
gated, 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 MEDICAL ASSISTANCE PROGRAM. The
provider shall submit notice to the insurer or plan administrator of his
or her exercise of such right of subrogation upon the provider's assign-
ment 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]. NOTWITHSTANDING ANY INCON-

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SISTENT 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  9.   This act shall take effect on the thirtieth day after it shall
have become a law; provided, however 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.