S T A T E O F N E W Y O R K
________________________________________________________________________
7996
2021-2022 Regular Sessions
I N A S S E M B L Y
June 4, 2021
___________
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to early intervention
and existing covered lives assessment funding; 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. Paragraph (b) of subdivision 6 of section 2807-t of the
public health law, as amended by section 13 of part Y of chapter 56 of
the laws of 2020, is amended to read as follows:
(b) Notwithstanding the provisions of paragraph (a) of this subdivi-
sion, for covered lives assessment rate periods on and after January
first, two thousand fifteen through December thirty-first, two thousand
twenty-three, for amounts collected in the aggregate in excess of one
billion forty-five million dollars on an annual basis, prospective
adjustments shall be suspended if the annual reconciliation calculation
from the prior year would otherwise result in a decrease to the regional
allocation of the specified gross annual payment amount for that region,
provided, however, that such suspension shall be lifted upon a determi-
nation by the commissioner, in consultation with the director of the
budget, that: (I) AS A FIRST PRIORITY, sixty-five million dollars in
aggregate collections on an annual basis over and above one billion
forty-five million dollars on an annual basis have been reserved and set
aside for deposit in the HCRA resources fund; AND (II) AS A SECOND
PRIORITY, THAT TWENTY MILLION DOLLARS IN AGGREGATE COLLECTIONS ON AN
ANNUAL BASIS OVER AND ABOVE ONE BILLION ONE HUNDRED MILLION DOLLARS, ON
AN ANNUAL BASIS HAVE BEEN RESERVED AND SET ASIDE FOR DEPOSIT IN THE HCRA
RESOURCES FUND FOR PURPOSES OF PAYMENTS TO THE EARLY INTERVENTION
SERVICES POOL, PURSUANT TO SECTION TWENTY-EIGHT HUNDRED SEVEN-O OF THIS
ARTICLE. Any amounts collected in the aggregate at or below one billion
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11665-01-1
A. 7996 2
forty-five million dollars on an annual basis, shall be subject to
regional adjustments reconciling any decreases or increases to the
regional allocation in accordance with paragraph (a) of this subdivi-
sion.
§ 2. 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. AS USED IN
THIS SECTION, THE FOLLOWING TERMS 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 (B) OF
SUBDIVISION SIX OF SECTION TWENTY-EIGHT HUNDRED SEVEN-T 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 BASED ON AVAILABLE FUND-
ING, COVERED LIVES ASSESSMENT 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.
§ 3. 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.]
§ 4. 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
A. 7996 3
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.
§ 5. Paragraph (b) of subdivision 5 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:
(b) Notwithstanding any inconsistent provision of section one hundred
twelve or one hundred sixty-three of the state finance law, sections one
hundred forty-two and one hundred forty-three of the economic develop-
ment law, or any other contrary provision of law, the commissioner is
authorized to enter into a contract or contracts under paragraph (a) of
this subdivision without a competitive bid or request for proposal proc-
ess, provided, however, that:
(i) The department shall post on its website, for a period of no less
than thirty days:
(1) A description of the proposed services to be provided pursuant to
the contract or contracts;
(2) The criteria for selection of a contractor or contractors;
(3) The period of time during which a prospective contractor may seek
selection, which shall be no less than thirty days after such informa-
tion is first posted on the website; and
(4) The manner by which a prospective contractor may seek such
selection, which may include submission by electronic means;
(ii) All reasonable and responsive submissions that are received from
prospective contractors in a timely fashion shall be reviewed by the
commissioner; [and]
(iii) SUCH FISCAL AGENT CONTRACTOR SHALL PAY CLAIMS IN ACCORDANCE WITH
THE TIMEFRAMES INCLUDED IN SECTION THIRTY-TWO HUNDRED TWENTY-FOUR-A OF
THE INSURANCE LAW, PROVIDED THAT SUCH FISCAL AGENT DEVELOP PROCESSES FOR
THE PROCESSING OF CLAIMS WHICH HAVE MINOR ERRORS WHERE THE LIABILITY AND
AMOUNT TO BE PAID IS CLEAR; AND
(IV) The commissioner shall select such contractor or contractors
that, in his or her discretion, are best suited to serve the purposes of
this section.
§ 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
A. 7996 4
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, PROVIDED SUCH FISCAL
AGENT COMPLIES WITH THE REQUIREMENTS OF SUBDIVISION FIVE OF SECTION
TWENTY-FIVE HUNDRED FIFTY-SEVEN OF THIS TITLE.
[(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-
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 IN THIS SUBDIVI-
SION, NO THIRD-PARTY PAYOR OTHER THAN THE MEDICAL ASSISTANCE PROGRAM
SHALL BE REQUIRED TO REIMBURSE FOR EARLY INTERVENTION SERVICES PROVIDED
PURSUANT TO 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 (l) of section
3221 of the insurance law is REPEALED.
A. 7996 5
§ 12. Paragraph 6 of subsection (ee) of section 4303 of the insurance
law is REPEALED.
§ 13. Section 2550 of the public health law is amended by adding a new
subdivision 4 to read as follows:
4. (A) THE LEAD AGENCY SHALL REVIEW THE INDIVIDUALIZED FAMILY SERVICE
PLAN (HEREINAFTER REFERRED TO AS "THE IFSP") FROM THE PREVIOUS CALENDAR
YEAR, DETERMINE THE APPROPRIATENESS OF THE CARE OR SERVICE RECEIVED AND
WHETHER THE SERVICE RECEIVED CONFORMS TO THE IFSP, AS OUTLINED IN
SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF THIS TITLE.
(B) THE AGENCY SHALL REVIEW THE NUMBER OF VISITS AND HOURS OF SERVICE
RENDERED AND DETERMINE WHETHER SERVICES WERE APPROPRIATE, COMPLETE AND
FULFILLED THE TERMS OF THE IFSP.
(C) THE FISCAL AGENT, IN DISPERSING REIMBURSEMENT FUNDS TO PROVIDERS,
SHALL FIRST ENSURE THAT THE CLAIM SUBMITTED BY PROVIDERS IS APPROPRIATE-
LY BILLED AND TECHNICALLY CORRECT.
§ 14. This act shall take effect January 1, 2022; provided, however,
that the amendments to section 2807-t of the public health law made by
section one of this act shall not affect the expiration of such section
and shall be deemed to expire therewith. Effective immediately, 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 on or before such effective date.