NY State Senate Bill 2017-S1727A

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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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 01, 2018	print number 1727a
Mar 01, 2018	amend (t) and recommit to health
Jan 03, 2018	referred to health
Jan 10, 2017	referred to health

Bill Amendments

Original

A (Active)

2017-S1727 - Details

See Assembly Version of this Bill:: A2569
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §2807-o, amd §§2807-s, 2557 & 2559, rpld §2543 sub 3, Pub Health L; rpld §3235-a, §3216 sub§ (i) ¶25 sub¶ (F), §3221 sub§ (l) ¶17 sub¶ (F), rpld §4303 sub§ (ee) ¶6, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: A6517
2015-2016: S4372, A273
2019-2020: S3338, A356
2021-2022: S5560, A5339

2017-S1727 - Summary

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

2017-S1727 - Sponsor Memo

                                 BILL NUMBER:  S1727

 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.

 LEGISLATIVE HISTORY :

S4372A/A273A, 2015-16 referred to Health/ways and means
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.

2017-S1727 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1727
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                             January 10, 2017
                                ___________
 
 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:
   §  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.

                                                            LBD01073-01-7

 S. 1727                             2
 
 STATE  AND  MUNICIPALITIES  ON ACCOUNT OF EARLY INTERVENTION SERVICES IN
 THE LAST COMPLETE STATE FISCAL YEAR FOR WHICH SUCH DATA IS AVAILABLE.
   §  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  EIGHTEEN  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.
   § 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 EIGHTEEN THROUGH
 DECEMBER THIRTY-FIRST, TWO THOUSAND EIGHTEEN.
   § 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.]
   §  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. 1727                             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
 EIGHTEEN  TO  DECEMBER THIRTY-FIRST, TWO THOUSAND EIGHTEEN, 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.
   §  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.
   § 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.
   § 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. 1727                             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.
   § 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. 1727                             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

2017-S1727A (ACTIVE) - Details

See Assembly Version of this Bill:: A2569
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §2807-o, amd §§2807-s, 2557 & 2559, rpld §2543 sub 3, Pub Health L; rpld §3235-a, §3216 sub§ (i) ¶25 sub¶ (F), §3221 sub§ (l) ¶17 sub¶ (F), rpld §4303 sub§ (ee) ¶6, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: A6517
2015-2016: S4372, A273
2019-2020: S3338, A356
2021-2022: S5560, A5339

2017-S1727A (ACTIVE) - Summary

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

2017-S1727A (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S1727A

SPONSOR: CARLUCCI
 
TITLE OF BILL:  An act to amend the public health law, in relation to
funding early intervention services; and to repeal certain provisions of
the public health law and the insurance law relating thereto

 
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 inter-
vention 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 expendi-
tures 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 muni-
cipality, 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 provid-
ing 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 maxi-
mum 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 disabili-
ties or reduce the severity of their disabling conditions.

All early intervention (EI) services must be provided to eligible chil-
dren at no cost to their families. The EI program is financed through a
combination of state and county funds, Medicaid and commercial insur-
ance. 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 insur-
ers; 70% of the claims were denied. Further, according to a survey by
the New York State Association of County Health Officials, for the peri-
od 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 adminis-
ter 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 esti-
mated 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, munici-
palities 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 inade-
quate, 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 esti-
mated 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 eligi-
ble 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.

 
LEGISLATIVE HISTORY:

S4372A/A273A, 2015-16 referred to Health/ways and means
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.

2017-S1727A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1727--A
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                             January 10, 2017
                                ___________
 
 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; and to repeal certain provisions of the  public
   health law and the insurance law relating thereto
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding  a  new  section
 2807-o to read as follows:
   §  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. PAYMENTS 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 PAYMENTS TO MUNICIPALITIES AND THE STATE FOR THE DELIVERY OF  EARLY
 INTERVENTION SERVICES.
   (B)  PAYMENTS  UNDER  THIS SUBDIVISION SHALL BE MADE TO MUNICIPALITIES
 AND THE STATE BY THE COMMISSIONER. EACH MUNICIPALITY AND  THE  STATE  OF
 NEW  YORK  SHALL  RECEIVE  A SHARE OF SUCH PAYMENTS EQUAL TO ITS PROPOR-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD01073-05-8

 S. 1727--A                          2
 
 TIONATE SHARE OF THE TOTAL APPROVED STATEWIDE DOLLARS  NOT  REIMBURSABLE
 BY  THE  MEDICAL  ASSISTANCE  PROGRAM  PAID TO PROVIDERS OF EARLY INTER-
 VENTION 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.
   § 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 THE STATE FISCAL YEAR TWO
 THOUSAND NINETEEN AND EACH STATE FISCAL YEAR THEREAFTER SHALL BE FIFTEEN
 MILLION DOLLARS.
   (H) THE AMOUNT SPECIFIED IN PARAGRAPH (G) OF THIS SUBDIVISION SHALL BE
 ALLOCATED UNDER SECTION TWENTY-EIGHT HUNDRED  SEVEN-O  OF  THIS  ARTICLE
 AMONG THE MUNICIPALITIES AND THE STATE OF NEW YORK BASED ON EACH MUNICI-
 PALITY'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.
   §  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: FIFTEEN MILLION DOLLARS FOR
 THE PERIOD BEGINNING APRIL FIRST, TWO THOUSAND NINETEEN, AND  CONTINUING
 EACH STATE FISCAL YEAR THEREAFTER.
   §  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] THE MEDICAL ASSISTANCE program under which
 an eligible child may have coverage.  [Nothing  in  this  section  shall
 increase  or enhance coverages provided for within an insurance contract
 subject to the provisions of this title.]
   § 5. 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

 S. 1727--A                          3
 
 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.
   § 6. The section heading of section 2559 of the public health law,  as
 added by chapter 428 of the laws of 1992, is amended to read as follows:
   [Third   party  insurance  and  medical]  MEDICAL  assistance  program
 payments.
   § 7. 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,
 hereinafter  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
 prior to claiming payment from  a  given  municipality  for  evaluations
 conducted  under the program and for services rendered to eligible chil-
 dren, 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 policy.
   (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] (B) 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)]  (C)  A  municipality,  or  its designee, and a provider shall be
 subrogated, to the extent of the expenditures by  such  municipality  or
 for  early intervention services furnished to persons eligible for bene-
 fits 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-

 S. 1727--A                          4
 
 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.
   § 8. Subdivision 3 of  section  2543  of  the  public  health  law  is
 REPEALED.
   § 9. Section 3235-a of the insurance law is REPEALED.
   §  10.  Subparagraph  (F) of paragraph 25 of subsection (i) of section
 3216 of the insurance law is REPEALED.
   § 11. Subparagraph (F) of paragraph 17 of subsection  (1)  of  section
 3221 of the insurance law is REPEALED.
   §  12. Paragraph 6 of subsection (ee) of section 4303 of the insurance
 law is REPEALED.
   § 13. This act shall take effect January 1, 2019;  provided,  however,
 that  the  amendments to section 2807-s of the public health law made by
 sections two and three of this act shall not affect  the  expiration  of
 such  section  and  shall be deemed to expire therewith. Effective imme-
 diately, the addition, amendment and/or repeal of any rule or regulation
 necessary for the implementation of this act on its effective  date  are
 authorized to be made and completed by the commissioner of health, on or
 before such effective date.

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Senate Bill S1727A

Sponsored By

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

2017-S1727 - Details

2017-S1727 - Summary

2017-S1727 - Sponsor Memo

2017-S1727 - Bill Text download pdf

co-Sponsors

2017-S1727A (ACTIVE) - Details

2017-S1727A (ACTIVE) - Summary

2017-S1727A (ACTIVE) - Sponsor Memo

2017-S1727A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S1727A

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Sponsored By

David Carlucci

Archive: Last Bill Status - In Senate Committee Health Committee

Bill Amendments

2017-S1727 - Details

2017-S1727 - Summary

2017-S1727 - Sponsor Memo

2017-S1727 - Bill Text download pdf

co-Sponsors

Rich Funke

2017-S1727A (ACTIVE) - Details

2017-S1727A (ACTIVE) - Summary

2017-S1727A (ACTIVE) - Sponsor Memo

2017-S1727A (ACTIVE) - Bill Text download pdf

Comments