Tuesday, March 25, 2014 2:00 am
By Kyle Adams Columbia-Greene Media
ALBANY — New York State Senator Cecilia Tkaczyk joined other lawmakers from the senate and assembly Monday afternoon to call for a solution to an administrative problem that has crippled many of the state’s Early Intervention service providers.
The problem stems from a 2011 budget measure that shifted responsibility for collecting third-party insurance payments for EI from counties to a state “fiscal agent,” which has left many small providers waiting months for payments and struggling under the administrative burden of filing claims.
“We are jeopardizing the services that help thousands of the most vulnerable children in our communities,” said Tkaczyk, D-Duanesburg. “We are also hurting small businesspeople who are extremely committed to providing these services and helping these children. We should be assisting them however we can to grow, create new jobs and help more children, rather than stifling them and putting them out of business.”
Early Intervention services aim to correct developmental problems early in life (up to age 3) to improve chances of success later on.
The switch to a state fiscal agent was supposed to manage the insurance claims in a more centralized manner — but providers said the roll-out was mismanaged from day one, and they spent much of 2013 waiting and hoping for reimbursements.
The new system has also placed the burden of filing insurance claims on the providers themselves, many of them sole proprietors, who did not have the training, time, expertise or resources to file the claims quickly and correctly.
“The providers are highly trained professionals in their field,” said Kelly Fagan, a speech language pathologist and EI provider in Greene County, last October. “But they’re not insurance examiners. We’re not big agencies. We don’t have a billing department. It’s just us.”
Tkaczyk’s proposed reform, which has been included in both the senate and assembly budget proposals, would require prompt payment to providers. The new EI fiscal agent — not the providers — would then work to pursue and recover payment from the insurance companies and Medicaid
In a press conference on Monday, John Hofmayer, deputy director of United New York Early Intervention Providers, said the billing situation has been a constant distraction and burden for providers.
“I have yet to meet a therapist or agency who has not suffered greatly through this transition,” he said. “There are skilled therapists who have left the field, agency owners who have closed their practices. Many who remain have maxed out their lines of credit, mortgaged their homes.”
Providers are still waiting, in some cases more than 100 days, for full payment of bills from November, he said.
“This system as it stands does not work,” he said. “Our fine providers should be spending their energy and focus on the children — not chasing claims and on whether or not they can pay their bills.”
Fagan said she has had to reduce the number of children she works with, and knows others who have had to find other work with a more reliable paycheck. As providers have gone out of business or reduced services, she said, counties have begun to feel the shortage.
“I have received three emails from three different counties this week that are basically begging providers to come back and asking for services for children as far away as 50 miles from where I live,” she wrote in an email. “It pains me to know that there are infants with severe disabilities either not getting services or getting very limited services due to this whole changeover to the SFA [state fiscal agent].”
She said in addition to timely payment, she’d like to see the administrative burden of filing claims placed on the fiscal agent, as Tkaczyk’s bill proposes.
“What needs to change is to get the SFA to do what the counties had been doing, what the legislators thought the bill they signed into law [in 2011] would do,” she said. “In order to have providers more willing to come back to EI after this year of sacrifice and uncertainty we need more than assurances that things will get better — we need this bill passed into law so that we have stability and we can get back to doing what we love, providing services to the needy infants and children in Early Intervention.”
Tkaczyk was joined Monday by senators George Latimer, D-Westchester, Gustavo Rivera, D-Bronx and Neil Breslin, D-Albany, and Assemblymembers Patricia Fahy, D-Albany, Shelley Mayer, D-Yonkers, and Thomas Abinanti, D-Mount Pleasant, in calling on Governor Andrew M. Cuomo and legislative leaders to include the fix in the final 2014-2015 budget.
The bill is supported by the New York State Speech-Language-Hearing Association, Agencies for Children’s Therapy Services, Interagency Council of Developmental Disabilities Agencies, NY Physical Therapy Association, the Alliance for Infants and Toddlers, New York State Occupational Therapy Association, and the United Cerebral Palsy Associations of New York.