BILL NUMBER: S3737

SPONSOR: BRESLIN
 
TITLE OF BILL:  An act to amend the insurance law, in relation to
coverage of early intervention services

 
PURPOSE:

To amend the insurance law to ensure recoupment from commercial insurers
for the cost of the early intervention program.

 
SUMMARY OF PROVISIONS:

Section one amends subsection (a) of section 3235-a of the insurance
law, as added by section 3 of part C of chapter 1 of the laws of 2002,
to prohibit accident and health insurance policies from excluding from
coverage services provided under title two-A of article twenty-five of
the public health law. Section one also amends section 3235-a to add two
new subsections (e) and (f). New subsection (e) provides that where a
service provided to an insured under the early intervention program is a
covered service under the insurer's policy, the individualized family
              

services plan, upon certification by the early intervention official,
shall be deemed to meet any precertification, preauthorization and
medical necessity requirements imposed on benefits under the policy. The
early intervention official shall remove or redact any information
contained in the individualized family services plan that is not
required by the insurer for payment purposes. Payment of a service
covered under the insurance policy shall be at rates established by the
Commissioner of Health for such service pursuant to regulations. New
subsection (f) provides that no insurer, including a health maintenance
organization, shall deny payment of an early intervention cl aim based
on the location where services are provided, the duration of the child's
condition and/or that the child's condition is not likely to signif-
icantly improve within the time specified in the policy, or that the
provider is not a network or participating provider.

Section two provides the effective date.

 
JUSTIFICATION:

Although public and private commercial insurance is required by law to
be maximized in financing early intervention (El) services, reimburse-
ment from third party payers, other than Medicaid, have been minimal
leaving the cost of this entitlement to be paid by state and municipal
tax dollars.

In recognition of the need to improve recoupment of insurance monies to
help pay for El, the Third Party Reimbursement Task Force of the New
York State Early Invention Coordinating Council was convened in 1999.
That Task Force examined data on billing and recoupment and found that
private insurance collection was at a low rate of 9%. An updated survey
conducted by the New York State Association of County Health Officials
of billing and recoupment in 2000 found that, while, the amount billed
to insurers had almost doubled, the recoupment rate remained a low 11%.

The Task Force also consulted with experts from Massachusetts, Indiana
and Virginia, all states that have included in state law the specific
requirements necessary to ensure insurance payments for El. Experts from
these three states indicated that requiring insurers to pay for El
services minimally impacted insurance premiums and that insurers may in
fact have saved money in the long run due to the therapeutic inter-
ventions under El. Experts from the three states confirmed the Task
Force's finding that the single most important factor to improve
collections as well as reducing administrative burdens was legislation
requiring private commercial insurers to pay for El.

Current insurance law does not include the necessary language to insure
that payments are made nor does the language preclude the majority of
reasons given for FT denials. As a result, it is necessary that specific
language be adopted to fix this problem.

 
LEGISLATIVE HISTORY:

2017-18 - S.3155/A.2026
2015-16 - S. 1946/A. 135 - Insurance Committee.

 
FISCAL IMPLICATIONS:

None to the state, savings for municipalities.

 
EFFECTIVE DATE:
Immediate.