NY State Senate Bill S5560A

Current Bill Status - Signed by Governor

Introduced
In Committee
On Floor Calendar
- Passed Senate
- Passed Assembly
Delivered to Governor
Signed by Governor

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Actions

view actions (16)

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Dec 30, 2021	signed chap.820
Dec 20, 2021	delivered to governor
Jun 10, 2021	returned to senate passed assembly ordered to third reading rules cal.557 substituted for a5339
Jun 09, 2021	referred to ways and means delivered to assembly passed senate
Apr 28, 2021	advanced to third reading
Apr 27, 2021	2nd report cal.
Apr 26, 2021	1st report cal.791
Apr 19, 2021	reported and committed to finance
Mar 16, 2021	print number 5560a
Mar 16, 2021	amend and recommit to health
Mar 11, 2021	referred to health

Votes

view votes

Jun 9, 2021 - floor Vote

S5560A

floor

Aye

Nay

Absent

Excused

Abstained

Apr 27, 2021 - Finance committee Vote

S5560A

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

Apr 20, 2021 - Health committee Vote

S5560A

committee

Aye

Nay

Aye with Reservations

Absent

Excused

Abstained

Bill Amendments

Original

A (Active)

Original

A (Active)

Co-Sponsors

S5560 - Details

See Assembly Version of this Bill:: A5339
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), §4303 sub§ (ee) ¶6, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: A6517
2015-2016: S4372, A273
2017-2018: S1727, A2569
2019-2020: S3338, A356

S5560 - Summary

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

S5560 - Sponsor Memo

 
BILL NUMBER: S5560

SPONSOR: REICHLIN-MELNICK
 
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:

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 PROVISIONS:

Section 1. amends the public health law by adding a new section 2807-o
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
payers 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 2. 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 3. 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 April 1, 2022 and continuing each subse-
quent year.

Section 4. amends subdivision 1 of section 2557 of the public health
law, to delete the reference to a plan of insurance so that benefits
under this title shall be considered secondary only to any state govern-
ment 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 5. amends subdivision 2 of section 2557 of the public health law
to provide that the department shall reimburse the approved costs paid
by a municipality other than' those reimbursable by the medical assist-
ance program, eliminating the exclusion of costs reimbursable by third
party payors.

Section 6. amends the section heading of section 2559 of the public
health law, to eliminate the reference to third party insurance.

Section 7. amends subdivision 3 of section 2559 of the public health
law, to provide that providers shall first seek payment from the medical
assistance program rather than third party payers 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. This section also
deletes paragraphs (b) requiring the commissioner to promulgate regu-
lations 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 inter-
vention services and (c) requiring that payments made for early inter-
vention 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 8 repeals subdivision 3 of section 2543 of the public health
law. Section 9 repeals section 3235-a of the insurance law.

Section 10 repeals subparagraph (F) of paragraph 25 of subsection (i) of
section 3216 of the insurance law.

Section 11 repeals subparagraph (F) of paragraph 17 of subsection (1) of
section 3221 of the insurance law.

Section 12 repeals paragraph 6 of subsection (ee) of section 4303 of the
insurance law.

Section 13 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 (El) services must be provided to eligible chil-
dren at no cost to their families. The El 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 payers, 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 El services were
filed with commercial insurers, of which $10.6 million, or 14%, were
paid. Counties, which are required by the State to finance and adminis-
ter the El program, are entitled to be reimbursed by the State for 50%
of their unreimbursed costs for El 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 El 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 El services, of
which only $800,000 was paid by commercial insurance, whereas in 1993 to
1994, the first year the El program became effective, the costs of El
services for the entire State was just $40 million.

Recognizing that the current structure of financing El 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 El 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 El 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 El program and thereby improve their
ability to more effectively administer El services to children who need
those services.

 
LEGISLATIVE HISTORY:

2019-20: S.3338 - Referred to Health
2017-18: S.1727A - Print Number 1727A 2015-16: S.4372A - Print Number
4372A

 
FISCAL IMPLICATIONS:

This bill will have no negative fiscal impact to the state and will in
fact generate revenue to the state. The state currently bears approxi-
mately 97% of the total El 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 shar-
ing 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.

S5560 - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5560
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                              March 11, 2021
                                ___________
 
 Introduced  by  Sens. REICHLIN-MELNICK, BROUK, MANNION -- 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; 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-
 TIONATE SHARE OF THE TOTAL APPROVED STATEWIDE DOLLARS  NOT  REIMBURSABLE
 BY  THE  MEDICAL  ASSISTANCE  PROGRAM  PAID TO PROVIDERS OF EARLY INTER-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD01949-01-1

 S. 5560                             2
 
 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-TWO  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-TWO, AND  CONTINU-
 ING 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
 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-

 S. 5560                             3
 
 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-
 ment as the early intervention service provider for the child. The right
 of subrogation does not attach to benefits paid or provided  [under  any

 S. 5560                             4

 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, 2022;  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.

Co-Sponsors

S5560A (ACTIVE) - Details

See Assembly Version of this Bill:: A5339
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), §4303 sub§ (ee) ¶6, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: A6517
2015-2016: S4372, A273
2017-2018: S1727, A2569
2019-2020: S3338, A356

S5560A (ACTIVE) - Summary

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

S5560A (ACTIVE) - Sponsor Memo

 
BILL NUMBER: S5560A         Revised 6/8/2021

SPONSOR: REICHLIN-MELNICK
 
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:

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 PROVISIONS:

Section one amends the public health law by adding a new section 2807-o
that provides definitions for terms used in this section of law. Section

one also provides that the commissioner of health shall make payments to
municipalities, for the delivery of early intervention services. Such
payments shall be a share of payments 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 twenty-two shall
be forty million dollars. Paragraph (h) provides that the forty million
dollars specified in paragraph (g) shall be allocated among the munici-
palities 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 forty million dollars
for the period beginning April 1, 2022 and continuing each state fiscal
year thereafter.

Section four amends 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,
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 subdivision 2 of section 2557 of the public health
law 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 six 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 seven 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 delete parts of paragraph (a). This
section 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 IFSP shall not be applied against any maxi-
mum lifetime or annual limits specified in the policy or health benefit
plan. In addition, section seven 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 eight repeals subdivision 3 of section 2543 of the public health
law. Section nine repeals section 3235-a of the insurance law.

Section ten repeals subparagraph (F) of paragraph 25 of subsection (i)
of section 3216 of the insurance law.

Section eleven repeals subparagraph (F) of paragraph 17 of subsection

(1) of section 3221 of the insurance law.

Section twelve repeals paragraph 6 of subsection (ee) of section 4303 of
the insurance law.

Section thirteen 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 (El) services must be provided to eligible chil-
dren at no cost to their families. The El program is financed through a
combination of state and county funds, Medicaid and commercial insur-
ance.  Counties, which are required by the State to finance and adminis-
ter the El program, are entitled to be reimbursed by the State for 50%
of their unreimbursed costs for El services (36% for administration
costs).

Although Public Health Law and IDEA mandate that public and private
commercial insurance be maximized in financing FT services, reimburse-
ment 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 2013, implementation of a statewide fiscal agent was designed to
increase third party reimbursement. Four years later, commercial payors
still deny claims. Since El claims billed to commercial insurance have
decreased as a percentage of total claims - with more being billed to
Medicaid - the dollar amount paid by commercial insurance has actually
decreased since the state hired the fiscal agent.

In 2017, approximately $70 million in claims was billed to commercial
insurance with only about $11.5 million paid from about 1.1 million
services rendered. As a result, 70% of the claims were denied.  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 El services.  Furthermore, the
prolonged and systematic underfunding of El providers has driven smaller
providers out of business and led to provider consolidation and
increased wait times for parents. From 2012 to 2015, the New York City
El office saw a 910% increase in the number of calls from parents unable
to find El providers for children who qualified for services.

Since a substantial portion of municipal budgets must be spent on El
services, municipalities must face a shrinking balance of available
funds, forcing them to decrease or eliminate altogether other needed
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.

Recognizing that the current structure of financing El 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 El costs. This bill would use the
covered lives assessment (a long-standing tax paid by health plans,
including self-insured plans) to contribute to the cost of the program.
Implementing this change would remove any obligation on insurers to pay
for El services and replace it with a lump sum payment, dramatically
reducing the administrative burden on providers as well as on the plans
themselves. For the first year, an amount of $40M would be paid into the
pool. This amount is based on the approximate percentage commercial
insurers pay of total El program cost(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.

This direct allocation of funds to municipalities from the statewide
pool will eliminate the unwieldy and inefficient step of requiring muni-
cipalities (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 avail-
able 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 that have been struggling to finance the El program.
It will improve the administration of El services to children who need
those services.

 
LEGISLATIVE HISTORY:

2019-20: S.3338 - Referred to Health

2017-18: S.1727A - Referred to Health

2015-16: S.4372A - Referred to Health

 
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 El 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 January 1, 2022; 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 immediately,
the addition, amendment and/or repeal of any rule or regulation neces-
sary 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.

S5560A (ACTIVE) - Bill Text download pdf

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5560--A
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                              March 11, 2021
                                ___________
 
 Introduced  by  Sens. REICHLIN-MELNICK, BROUK, MANNION -- read twice and
   ordered printed, and when printed to be committed to the Committee  on
   Health  --  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-
 TIONATE  SHARE  OF THE TOTAL APPROVED STATEWIDE DOLLARS NOT REIMBURSABLE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD01949-03-1

 S. 5560--A                          2
 
 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-TWO AND EACH STATE FISCAL YEAR THEREAFTER SHALL BE FORTY
 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: FORTY MILLION DOLLARS FOR  THE
 PERIOD  BEGINNING  APRIL  FIRST, TWO THOUSAND TWENTY-TWO, 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
 state reimbursement to the municipality shall not be paid prior to April

 S. 5560--A                          3
 
 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-
 ment as the early intervention service provider for the child. The right

 S. 5560--A                          4
 
 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, 2022; 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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The New York State Senate

senate Bill S5560A

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senate Bill S5560A

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Sponsored By

Current Bill Status - Signed by Governor

Your Voice

Actions

Votes

Jun 9, 2021 - floor Vote

Floor Vote: Jun 9, 2021

Apr 27, 2021 - Finance committee Vote

Finance Committee Vote: Apr 27, 2021

Apr 20, 2021 - Health committee Vote

Health Committee Vote: Apr 20, 2021

Bill Amendments

Co-Sponsors

S5560 - Details

S5560 - Summary

S5560 - Sponsor Memo

S5560 - Bill Text download pdf

Co-Sponsors

S5560A (ACTIVE) - Details

S5560A (ACTIVE) - Summary

S5560A (ACTIVE) - Sponsor Memo

S5560A (ACTIVE) - Bill Text download pdf

Comments