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

                                 273--A

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 7, 2015
                               ___________

Introduced  by  M.  of A. PAULIN, GOTTFRIED, CAHILL, CLARK, COOK, GALEF,
  GUNTHER, JAFFEE, LIFTON, MARKEY, LAVINE, MAGNARELLI,  DINOWITZ,  BENE-
  DETTO,  LUPARDO,  TITONE -- read once and referred to the Committee on
  Health -- recommitted to the Committee on Health  in  accordance  with
  Assembly  Rule  3, sec. 2 -- reported and referred to the Committee on
  Ways  and  Means  --  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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD00282-03-6
              

A. 273--A                           2

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
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;

A. 273--A                           3

  (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;
  (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.

A. 273--A                           4

  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
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

A. 273--A                           5

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
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.