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This entry was published on 2022-01-07
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Financial responsibility and reimbursement
Public Health (PBH) CHAPTER 45, ARTICLE 25, TITLE 2-A
§ 2557. Financial responsibility and reimbursement. 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 eligible
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
regulations 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 the medical
assistance program under which an eligible child may have coverage.

2. The department shall reimburse the approved costs paid by a
municipality for the purposes of this title, other than those
reimbursable by the medical assistance program, 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
municipality, 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.

3. The department may perform audits, which may include site
visitation, to all or any of the following: municipalities; service
coordinators; evaluators or providers of early intervention services.
The department shall provide the municipalities with a copy of the
findings of such audits. Early intervention program state aid
reimbursement or portion thereof may be withheld if, on post-audit and
review, the commissioner finds that the early intervention services were
not provided or those provided were not in substantial conformance with
the rules and regulations established by the commissioner or that the
recipient of such services was not an eligible child as defined in
section twenty-five hundred forty-one of this title. In the event that
the commissioner determines that there may be a withholding of state
reimbursement to any municipality under this section, he shall inform
the state early intervention coordinating council and the relevant local
early intervention coordinating council and shall consider alternative
courses of action recommended within sixty days by either body prior to
withholding state reimbursement.

3-a. Each municipality may perform an audit, which may include site
visitation, of evaluators and providers of such services within its
municipality in accordance with standards established by the
commissioner. The municipality shall submit the results of any such
audit to the commissioner for review and, if warranted, adjustments in
state aid reimbursement pursuant to subdivision three of this section,
as well as for recovery by the municipality of its share of any
disallowances identified in such audit.

5. (a) The commissioner, in his or her discretion, is authorized to
contract with one or more entities to act as the fiscal agent for the
department and municipalities with respect to fiscal management and
payment of early intervention claims. Municipalities shall grant
sufficient authority to the fiscal agent to act on their behalf.
Municipalities, and individual and agency providers as defined by the
commissioner in regulation shall utilize such fiscal agent for payment
of early intervention claims as determined by the department and shall
provide such information and documentation as required by the department
and necessary for the fiscal agent to carry out its duties.

(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
development 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 process, 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
information 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) The commissioner shall select such contractor or contractors
that, in his or her discretion, are best suited to serve the purposes of
this section.

(c) Paragraph (b) of this subdivision shall apply only to the initial
contract or contracts necessary to obtain the services of a fiscal agent
for early intervention program fiscal management and payment of early
intervention claims and shall not apply to subsequent contracts needed
to maintain such services, as determined by the commissioner in his or
her discretion.