S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    356
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 9, 2019
                                ___________
 
 Introduced  by M. of A. PAULIN, GOTTFRIED, CAHILL, COOK, GALEF, GUNTHER,
   JAFFEE, LIFTON, MAGNARELLI, DINOWITZ,  BENEDETTO,  LUPARDO,  ABINANTI,
   CROUCH,  M. G. MILLER  --  read  once and referred to the Committee on
   Health
 
 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.
                                                            LBD00634-01-9

 A. 356                              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 TWENTY 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 TWENTY, 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

 A. 356                              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-

 A. 356                              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, 2020;  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.