BILL NUMBER: S4866

SPONSOR: FAHY
 
TITLE OF BILL:

An act to amend the mental hygiene law, in relation to reimbursement of
certain programs and services for persons with a disability

 
PURPOSE:

The purpose of this bill is to ensure local service providers are reim-
bursed from the Office for People with Developmental Disabilities, for
the rendering of approved services, while such approval is pending.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of this bill would amend the Mental Hygiene Law by adding a
new section 43.13 to provide for the reimbursement of a service
furnished by a local service provider while the Commissioner approves
the service, provided that such approval is ultimately granted. This
section also provides that if a service is ultimately not approved and
reimbursement has already occurred, such reimbursement shall be returned
              

to the Office for People with Developmental Disabilities within sixty
days of notice of such denial.

Section 2 of this bill provides that the effective date shall take
effect immediately.

 
JUSTIFICATION:

Services rendered to persons with developmental disabilities by local
service providers and agencies must be approved the Office for Persons
with Developmental Disabilities (OPWDD). Generally, an individual, or a
family member on the behalf of an individual, will approach a local
service provider seeking disability services. That individual is then
referred to OPWDD for an evaluative process during which OPWDD will
determine the services that are available to the person and which
centers provide the approved services. A family may choose only from the
services and centers approved through OPWDD's assessment.

A local provider is proscribed from providing any service to a person
with a developmental disability until such service is approved by OPWDD.
Often, an initial placement in a particular program or the rendering of
specific services is inappropriate for the individual requiring the
service. This may result in extraordinary hardships for both the indi-
vidual and that person's caregivers, especially when the inappropriate
placement results in physical or emotional harm to the individual, or
when abridgement in service results in a lapse of day care thus forcing
the caregiver to modify his or her own employment obligations. Further-
more, local service providers cannot help facilitate the evaluation and
approval process and are prevented from advocating on behalf of their
clients and families.

In an effort to offer the necessary services and treatments to all of
their clients in a streamlined and consistent manner, local service
providers often provide uncompensated care. But uncompensated care does
does not mean that the services provided were not approved by OPWDD.
Rather, the uncompensated care may have been administered while the
individual was still being approved, or during an interim period when
OPWDD had not yet approved a more appropriate placement or treatment for
that person's particular needs.

This bill requires that if a person with developmental disabilities
qualifying for such a program and has entered into a program or received
a service furnished by a local service provider, and subsequently enters
into a different program or receives a different service not yet
approved by OPWDD, the local service provider must be reimbursed the
cost of that program or service as if it had been approved prior to such
person's admission to the program, provided that such approval is ulti-
mately granted by the Department.

While only those services that are ultimately approved by OPWDD quality
for reimbursement during the interim period, this bill will promote the
consistent delivery of necessary services to persons with developmental
disabilities and ensure local service providers are appropriately
compensated for the rendering of such approved services. This legis-
lation will foster the relationship between all of these parties,
including individuals with developmental disabilities and their fami-
lies, local service providers, and OPWDD. As such it is imperative that
this bill is enacted.

 
LEGISLATIVE HISTORY:

2023/24: S.3140

2021-22: S.4468-A

2019-20: S.4013

2017-18: S.1916

2015-16: S.5544-A

 
FISCAL IMPLICATION:

Minimal.

 
EFFECTIVE DATE:
This act shall take effect immediately.