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This entry was published on 2022-01-07
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Medical assistance program payments
Public Health (PBH) CHAPTER 45, ARTICLE 25, TITLE 2-A
§ 2559. Medical assistance program payments. 1. Nothing in this title
shall be construed to permit the department or any other state agency or
municipality to reduce medical assistance or other assistance or
services available to eligible children.

2. Notwithstanding any other provisions of law, costs incurred for
early intervention services that otherwise qualify as medical assistance
that are furnished to an eligible child who is also eligible for
benefits pursuant to title eleven of article five of the social services
law are considered to be medical assistance for purposes of payments to
providers and state reimbursement to the extent that federal financial
participation is available therefor.

3. (a) Parents shall provide the municipality and the service
coordinator with a written referral from a primary care provider as
documentation, for eligible children, of the medical necessity of early
intervention services.

(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.

(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
benefits under this title, to any rights such person may have or be
entitled to from 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 assignment as
the early intervention service provider for the child. The right of
subrogation does not attach to benefits paid or provided prior to
receipt of written notice of the exercise of subrogation rights.
Notwithstanding any inconsistent 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.

4. Notwithstanding any other provision of law, the commissioner,
pursuant to a memorandum of understanding with the commissioner of the
office for people with developmental disabilities, shall develop and
submit a medicaid home and community based services waiver, pursuant to
section 1915c of the social security act, for the purpose of creating a
waiver program to provide and finance services for children who qualify
for the early intervention program. In further establishing eligibility
criteria under the waiver program, the commissioner, in conjunction with
the commissioner of the office for people with developmental
disabilities, shall establish health, developmental and psycho-social
criteria which shall permit the broadest eligibility based on criteria
for the early intervention program and federal standards for
participation in a waiver program. The waiver application shall be
submitted pursuant to section 1915c of the social security act no later
than January first, two thousand four.

5. Notwithstanding any law to the contrary, there is hereby
established an early intervention demonstration project to be conducted
in Albany, Montgomery, Rensselaer, Saratoga and Schenectady Counties.
Such project shall be for the purposes of facilitating coverage
eligibility determinations and claims submissions for early intervention
services. The commissioner is hereby authorized and directed to
facilitate and, within the amounts appropriated, shall award grant funds
for the implementation and operation of such demonstration project which
shall be conducted by an association representative of health
maintenance organizations licensed under article forty-four of this
chapter and article forty-three of the insurance law in conjunction with
the commissioner and the counties specified in this subdivision.

Such demonstration shall include the development of an integrated web
portal enabling access to health plan data bases to facilitate coverage
eligibility, benefit determinations and claims submission and
processing. Such access shall be subject to all federal and state laws
for the confidentiality of personal and medical record information. The
demonstration will develop technology solutions to facilitate coverage
determinations and streamline and monitor claims processes and payment.

The association conducting the demonstration, the commissioner and
participating counties shall submit a report to the temporary president
of the senate and the speaker of the assembly, not later than one year
following the commencement of the program's operation, describing the
experiences, feasibility and advisability of replication, and any
additional recommendations for continuation, modification or cessation
of the program.