NY State Senate Bill 2015-S4372A

Archive: Last Bill Status - In Senate Committee Health 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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Actions

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 14, 2016	print number 4372a
Jan 14, 2016	amend and recommit to health
Jan 06, 2016	referred to health
Mar 17, 2015	referred to health

Bill Amendments

Original

A (Active)

2015-S4372 - Details

See Assembly Version of this Bill:: A273
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §2807-o, amd §§2807-s, 2557 & 2559, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2013-2014: A6517
2017-2018: S1727, A2569
2019-2020: S3338, A356
2021-2022: S5560, A5339

2015-S4372 - Summary

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

2015-S4372 - Sponsor Memo

                                BILL NUMBER:S4372

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 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
2807-0 that provides definitions for terms used in this section of
law. Section one also provides that the commissioner of health shall
make grants to municipalities for the delivery of early intervention
services. Such grants shall be deemed reimbursements from third party
payors to the municipalities and the State and shall be a share of
grants equal to the proportionate share of the municipality and the
State, as the case may be, of the total approved statewide dollars not
reimbursable, by the medical assistance program paid by municipalities
and the State to providers of early intervention services in the last
complete state fiscal year for which such data is 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
sixteen shall be one hundred fifteen million dollars. Paragraph (h)
provides that the one hundred fifteen million dollars specified in
paragraph (g) shall be allocated among the municipalities and the
State based on the share of each municipality and the State 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 2807-s of the public
health law by adding a new paragraph (d) that provides that funds
shall be added to the funds collected by the commissioner for
distribution in accordance with section 2807-o, in the amount of one
hundred fifteen million dollars for the period January 1, 2016 through
December 31, 2016.

Section four amends subdivision 1 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, to delete the reference to a plan of insurance so
that benefits under this title shall be considered secondary only to
any state government benefit program under which an eligible child may
have coverage, and to delete the provision that nothing in this
section shall increase or enhance coverages provided for within an
insurance contract subject to the provisions of this title.

Section five amends section 2557 of the public health law by adding a
new subdivision 4 to require the commissioner to collect data, by
municipality, on the early intervention program for purposes of
improving the efficiency, cost effectiveness and quality of the


program. Data to be collected shall include the number of children
enrolled in the program, the number of state-approved agencies and
organizations providing early intervention services by service
specialty and the number of state-approved independent providers of
early intervention services by service specialty, the number of
state-approved evaluators, the number of children covered by the
medical assistance program, the number of claims submitted to the
medical assistance program by municipality, the percentage claims
denied by medical assistance and the reasons for the denials. The
commissioner shall report for the period July 1, 2016 to December 31,
2016 and for each calendar year thereafter, to the Governor and the
Legislature by March 1 of each year the information and analysis
required by this section.

Section six amends 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, to provide that the department shall reimburse the approved
costs paid by a municipality other than those reimbursable by the
medical assistance program, eliminating the exclusion of costs
reimbursable by third party payors.

Section seven amends the section heading of section 2559 of the public
health law, as added by chapter 428 of the laws of 1992, to eliminate
the reference to third party insurance.

Section eight amends 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, to provide that providers
shall first seek payment from the medical assistance program rather
than third party payors including governmental agencies, 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 eight also deletes paragraphs (b) requiring 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) requiring that
payments made for early intervention services under an insurance
policy or health benefit plan provided as part of an IFSF shall not be
applied against any maximum lifetime or annual limits specified in the
policy or health benefit plan. In addition, section eight 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 nine provides the effective date.

JUSTIFICATION: The early intervention program was established under
the Public Health Law and the federal Individuals with Disabilities


Education Act (IDEA) to enhance the development of infants and
toddlers from birth to age three who have a significant developmental
delay or disability, as well as enhance the capacity of families to
meet their children's special needs. The program seeks to identify and
evaluate as early as possible those infants and toddlers whose healthy
development is compromised and to provide for appropriate therapeutic
and supportive services. With early intervention, we can reduce the
number of children with disabilities or reduce the severity of their
disabling conditions.

All early intervention (EI) services must be provided to eligible
children at no cost to their families. The EI program is financed
through a combination of state and county funds, Medicaid and
commercial insurance. Although Public Health Law and IDEA mandate that
public and private commercial insurance be maximized in financing El
services, reimbursement from third party payors, 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, which 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, overshadowing 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 EI services for the entire State was $40
million. Since a substantial portion of municipal budgets must be
spent on EI services, municipalities 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
inadequate, this bill provides a different approach to funding. The
bill would set up a statewide pool from which municipalities and the
State would be allocated funds to pay RI costs. For the first year, an
amount of $115M would be paid into the pool. This amount is based on
the approximate percentage commercial insurers pay of total EI program
costs (utilizing data from the 2012-13 program year) increased by the
estimated amount paid by commercial insurers related to mandated
coverage for autism spectrum disorder.


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 case where the insured is not
eligible for medical assistance) to seek reimbursement of El 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 and the State will provide
vital relief to the State and the municipalities across the state that
have been struggling to finance the EI program and thereby improve
their ability to more effectively administer EI services to children
who need those services.

PRIOR LEGISLATIVE HISTORY: A.6517-A, 2013 and 2014 referred to health.
A.812, 2011 and 2012 reported referred to ways and means. A.4058-A,
2009 reported referred to ways and means and 2010 held for
consideration in ways and means. A.6814-A, 2007 reported referred to
ways and means and 2008 amended and recommitted to ways and means.

FISCAL IMPLICATIONS: This bill will have no fiscal impact to the State
and will in fact generate revenue to the State. The State currently
bears approximately 97% of the total EI program costs, with commercial
insurers paying 3%. The bill contemplates that commercial insurers
will pay into a fund 15% of the program costs with the State and
municipalities sharing such funded amount.

EFFECTIVE DATE: This act shall take effect on the thirtieth day after
it shall 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.

2015-S4372 - Bill Text download pdf

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

                                  4372

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             March 17, 2015
                               ___________

Introduced  by Sen. CARLUCCI -- read twice and ordered printed, and when
  printed to be committed 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 AND THE STATE OF NEW YORK FOR THE PURPOSES OF  THE  EARLY
INTERVENTION PROGRAM.
  (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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00282-01-5

S. 4372                             2

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 SIXTEEN 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  SIXTEEN  THROUGH
DECEMBER THIRTY-FIRST, TWO THOUSAND SIXTEEN.
  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;
  (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;

S. 4372                             3

  (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
SIXTEEN  TO  DECEMBER  THIRTY-FIRST,  TWO THOUSAND SIXTEEN, 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:
  [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

S. 4372                             4

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-
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

S. 4372                             5

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.

co-Sponsors

2015-S4372A (ACTIVE) - Details

See Assembly Version of this Bill:: A273
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §2807-o, amd §§2807-s, 2557 & 2559, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2013-2014: A6517
2017-2018: S1727, A2569
2019-2020: S3338, A356
2021-2022: S5560, A5339

2015-S4372A (ACTIVE) - Summary

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

2015-S4372A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S4372A

 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 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
2807-0 that provides definitions for terms used in this section of
law. Section one also provides that the commissioner of health shall
make grants to municipalities for the delivery of early intervention
services. Such grants shall be deemed reimbursements from third party
payors to the municipalities and the State and shall be a share of
grants equal to the proportionate share of the municipality and the
State, as the case may be, of the total approved statewide dollars not
reimbursable, by the medical assistance program paid by municipalities

and the State to providers of early intervention services in the last
complete state fiscal year for which such data is 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
seventeen shall be one hundred fifteen million dollars. Paragraph (h)
provides that the one hundred fifteen million dollars specified in
paragraph (g) shall be allocated among the municipalities and the
State based on the share of each municipality and the State 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 2807-s of the public
health law by adding a new paragraph (d) that provides that funds
shall be added to the funds collected by the commissioner for
distribution in accordance with section 2807-o, in the amount of one
hundred fifteen million dollars for the period January 1, 2017 through
December 31, 2017.

Section four amends subdivision 1 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, to delete the reference to a plan of insurance so
that benefits under this title shall be considered secondary only to
any state government benefit program under which an eligible child may
have coverage, and to delete the provision that nothing in this
section shall increase or enhance coverages provided for within an
insurance contract subject to the provisions of this title.

Section five amends section 2557 of the public health law by adding a
new subdivision 4 to require the commissioner to collect data, by
municipality, on the early intervention program for purposes of
improving the efficiency, cost effectiveness and quality of the
program. Data to be collected shall include the number of children
enrolled in the program, the number of state-approved agencies and
organizations providing early intervention services by service
specialty and the number of state-approved independent providers of
early intervention services by service specialty, the number of
state-approved evaluators, the number of children covered by the
medical assistance program, the number of claims submitted to the
medical assistance program by municipality, the percentage claims
denied by medical assistance and the reasons for the denials. The
commissioner shall report for the period July 1, 2017 to December 31,
2017 and for each calendar year thereafter, to the Governor and the
Legislature by March 1 of each year the information and analysis
required by this section.

Section six amends 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, to provide that the department shall reimburse the approved
costs paid by a municipality other than those reimbursable by the
medical assistance program, eliminating the exclusion of costs
reimbursable by third party payors.

Section seven amends the section heading of section 2559 of the public
health law, as added by chapter 428 of the laws of 1992, to eliminate
the reference to third party insurance.

Section eight amends 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, to provide that providers
shall first seek payment from the medical assistance program rather
than third party payors including governmental agencies, 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 eight also deletes paragraphs (b) requiring 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) requiring that
payments made for early intervention services under an insurance
policy or health benefit plan provided as part of an IFSF shall not be
applied against any maximum lifetime or annual limits specified in the
policy or health benefit plan. In addition, section eight 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 nine provides the effective date.

 JUSTIFICATION :

The early intervention program was established under the Public Health
Law and the federal Individuals with Disabilities Education Act (IDEA)
to enhance the development of infants and toddlers from birth to age
three who have a significant developmental delay or disability, as
well as enhance the capacity of families to meet their children's
special needs. The program seeks to identify and evaluate as early as
possible those infants and toddlers whose healthy development is
compromised and to provide for appropriate therapeutic and supportive
services. With early intervention, we can reduce the number of
children with disabilities or reduce the severity of their disabling
conditions.

All early intervention (EI) services must be provided to eligible
children at no cost to their families. The EI program is financed
through a combination of state and county funds, Medicaid and
commercial insurance. Although Public Health Law and IDEA mandate that
public and private commercial insurance be maximized in financing El
services, reimbursement from third party payors, 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, which 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, overshadowing 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 EI services for the entire State was $40
million. Since a substantial portion of municipal budgets must be
spent on EI services, municipalities 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
inadequate, this bill provides a different approach to funding. The
bill would set up a statewide pool from which municipalities and the
State would be allocated funds to pay RI costs. For the first year, an
amount of $115M would be paid into the pool. This amount is based on
the approximate percentage commercial insurers pay of total EI program
costs (utilizing data from the 2012-13 program year) increased by the
estimated amount paid by commercial insurers related to mandated
coverage for autism spectrum disorder.

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 case where the insured is not
eligible for medical assistance) to seek reimbursement of El 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 and the State will provide
vital relief to the State and the municipalities across the state that
have been struggling to finance the EI program and thereby improve
their ability to more effectively administer EI services to children
who need those services.

 PRIOR LEGISLATIVE HISTORY :

A.6517-A, 2013 and 2014 referred to health.
A.812, 2011 and 2012 reported referred to ways and means.

A.4058-A, 2009 reported referred to ways and means and 2010 held for
consideration in ways and means.
A.6814-A, 2007 reported referred to ways and means and 2008 amended
and recommitted to ways and means.

 FISCAL IMPLICATIONS :

This bill will have no fiscal impact to the State and will in fact
generate revenue to the State. The State currently bears approximately
97% of the total EI program costs, with commercial insurers paying 3%.
The bill contemplates that commercial insurers will pay into a fund
15% of the program costs with the State and municipalities sharing
such funded amount.

 EFFECTIVE DATE :
This act shall take effect on the thirtieth day after it shall 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.

2015-S4372A (ACTIVE) - Bill Text download pdf

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

                                 4372--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                             March 17, 2015
                               ___________

Introduced  by Sen. CARLUCCI -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health --  recommitted  to
  the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
  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.
  (B) GRANTS UNDER THIS SUBDIVISION SHALL BE AWARDED  TO  MUNICIPALITIES
BY  THE  COMMISSIONER. EACH MUNICIPALITY AND THE STATE OF NEW YORK SHALL

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00282-02-6

S. 4372--A                          2

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 SEVENTEEN 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  SEVENTEEN  THROUGH
DECEMBER THIRTY-FIRST, TWO THOUSAND SEVENTEEN.
  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;
  (C)  THE  TOTAL  NUMBER  OF CHILDREN, WITHIN A MUNICIPALITY, RECEIVING
MULTIPLE SERVICES, THE PERCENTAGE OF THOSE CHILDREN BY SERVICE TYPE, THE

S. 4372--A                          3

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
SEVENTEEN TO DECEMBER THIRTY-FIRST, TWO THOUSAND SEVENTEEN, 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:
  [Third   party  insurance  and  medical]  MEDICAL  assistance  program
payments.

S. 4372--A                          4

  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-
SISTENT PROVISION OF THIS TITLE, EXCEPT AS PROVIDED FOR HEREIN, NO THIRD

S. 4372--A                          5

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.

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Senate Bill S4372A

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Sponsored By

David Carlucci

Archive: Last Bill Status - In Senate Committee Health Committee

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George Latimer

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