Bill Text: NY A00356 | 2019-2020 | General Assembly | Introduced

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

Spectrum: Strong Partisan Bill (Democrat 14-1)

Status: (Introduced) 2019-01-15 - reported referred to ways and means [A00356 Detail]

Download: New_York-2019-A00356-Introduced.html

                STATE OF NEW YORK
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                     January 9, 2019
        Introduced  by M. of A. PAULIN, GOTTFRIED, CAHILL, COOK, GALEF, GUNTHER,
          CROUCH,  M. G. MILLER  --  read  once and referred to the Committee on
        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:
     1    Section  1.  The  public health law is amended by adding a new section
     2  2807-o to read as follows:
     3    § 2807-o.  Early  intervention  services  pool.  1.  Definitions.  The
     4  following  words  or  phrases  as  used  in  this section shall have the
     5  following meanings:
     6    (a) "Early intervention services" shall mean services delivered to  an
     7  eligible  child, pursuant to an individualized family service plan under
     8  the early intervention program.
     9    (b) "Early intervention program" shall  mean  the  early  intervention
    10  program  for toddlers with disabilities and their families as created by
    11  title two-A of article twenty-five of this chapter.
    12    (c) "Municipality" shall mean any county outside of the  city  of  New
    13  York or the city of New York.
    14    2.  Payments  for  early  intervention  services. (a) The commissioner
    15  shall, from funds allocated for such  purpose  under  paragraph  (g)  of
    16  subdivision six of section twenty-eight hundred seven-s of this article,
    17  make  payments to municipalities and the state for the delivery of early
    18  intervention services.
    19    (b) Payments under this subdivision shall be  made  to  municipalities
    20  and  the  state  by the commissioner. Each municipality and the state of
    21  New York shall receive a share of such payments  equal  to  its  propor-
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 356                              2
     1  tionate  share  of the total approved statewide dollars not reimbursable
     2  by the medical assistance program paid  to  providers  of  early  inter-
     3  vention  services  by  the  state and municipalities on account of early
     4  intervention  services  in the last complete state fiscal year for which
     5  such data is available.
     6    § 2. Subdivision 6 of section 2807-s  of  the  public  health  law  is
     7  amended by adding two new paragraphs (g) and (h) to read as follows:
     8    (g)  A  further  gross  statewide amount for the state fiscal year two
     9  thousand twenty and each state fiscal year thereafter shall  be  fifteen
    10  million dollars.
    11    (h) The amount specified in paragraph (g) of this subdivision shall be
    12  allocated  under  section  twenty-eight  hundred seven-o of this article
    13  among the municipalities and the state of New York based on each munici-
    14  pality's share and the  state's  share  of  early  intervention  program
    15  expenditures  not reimbursable by the medical assistance program for the
    16  latest twelve month period for which such data is available.
    17    § 3. Subdivision 7 of section 2807-s  of  the  public  health  law  is
    18  amended by adding a new paragraph (d) to read as follows:
    19    (d)  funds  shall  be added to the funds collected by the commissioner
    20  for distribution in accordance with section twenty-eight hundred seven-o
    21  of this article, in the following amount: fifteen  million  dollars  for
    22  the  period  beginning  April first, two thousand twenty, and continuing
    23  each state fiscal year thereafter.
    24    § 4. Subdivision 1 of section  2557  of  the  public  health  law,  as
    25  amended  by  section  4  of  part C of chapter 1 of the laws of 2002, is
    26  amended to read as follows:
    27    1. The approved costs for an eligible child who receives an evaluation
    28  and early intervention services pursuant to this title shall be a charge
    29  upon the municipality wherein the eligible child resides or,  where  the
    30  services  are covered by the medical assistance program, upon the social
    31  services district of fiscal responsibility with respect to those  eligi-
    32  ble  children who are also eligible for medical assistance. All approved
    33  costs shall be paid in the first instance and at least quarterly by  the
    34  appropriate  governing body or officer of the municipality upon vouchers
    35  presented and audited in the same manner as the  case  of  other  claims
    36  against  the  municipality.  Notwithstanding  the insurance law or regu-
    37  lations thereunder relating to the permissible exclusion of payments for
    38  services under governmental programs, no such exclusion shall apply with
    39  respect to payments made pursuant to  this  title.  Notwithstanding  the
    40  insurance  law  or  any other law or agreement to the contrary, benefits
    41  under this title shall be considered secondary to [any plan of insurance
    42  or state government benefit] the medical assistance program under  which
    43  an  eligible  child  may  have  coverage. [Nothing in this section shall
    44  increase or enhance coverages provided for within an insurance  contract
    45  subject to the provisions of this title.]
    46    §  5.  Subdivision  2  of  section  2557  of the public health law, as
    47  amended by section 9-a of part A of chapter 56 of the laws of  2012,  is
    48  amended to read as follows:
    49    2. The department shall reimburse the approved costs paid by a munici-
    50  pality  for the purposes of this title, other than those reimbursable by
    51  the medical assistance program [or by third party payors], in an  amount
    52  of fifty percent of the amount expended in accordance with the rules and
    53  regulations   of  the  commissioner;  provided,  however,  that  in  the
    54  discretion of the department and with the approval of  the  director  of
    55  the  division of the budget, the department may reimburse municipalities
    56  in an amount greater than fifty percent of  the  amount  expended.  Such

        A. 356                              3
     1  state reimbursement to the municipality shall not be paid prior to April
     2  first  of  the  year in which the approved costs are paid by the munici-
     3  pality, provided, however that, subject to the approval of the  director
     4  of  the  budget,  the department may pay such state aid reimbursement to
     5  the municipality prior to such date.
     6    § 6. The section heading of section 2559 of the public health law,  as
     7  added by chapter 428 of the laws of 1992, is amended to read as follows:
     8    [Third   party  insurance  and  medical]  Medical  assistance  program
     9  payments.
    10    § 7. Subdivision 3 of section 2559 of the public health law, as  added
    11  by  chapter  428  of  the  laws  of 1992, paragraphs (a), (c) and (d) as
    12  amended by section 11 of part A of chapter 56 of the laws  of  2012  and
    13  paragraph  (b) as further amended by section 104 of part A of chapter 62
    14  of the laws of 2011, is amended to read as follows:
    15    3. (a) [Providers of  evaluations  and  early  intervention  services,
    16  hereinafter  collectively  referred to in this subdivision as "provider"
    17  or "providers", shall in the first instance and where  applicable,  seek
    18  payment  from  all  third  party  payors including governmental agencies
    19  prior to claiming payment from  a  given  municipality  for  evaluations
    20  conducted  under the program and for services rendered to eligible chil-
    21  dren, provided that, the obligation to seek payment shall not apply to a
    22  payment from a third party payor who is  not  prohibited  from  applying
    23  such  payment,  and  will  apply  such payment, to an annual or lifetime
    24  limit specified in the insured's policy.
    25    (i) Parents shall provide the  municipality  and  service  coordinator
    26  information  on  any  insurance  policy, plan or contract under which an
    27  eligible child has coverage.
    28    (ii)] Parents shall provide the municipality and the service coordina-
    29  tor with a written referral from a primary care provider  as  documenta-
    30  tion,  for  eligible  children, of the medical necessity of early inter-
    31  vention services.
    32    [(iii) providers] (b) Providers shall utilize the department's  fiscal
    33  agent  and data system for claiming payment for evaluations and services
    34  rendered under the early intervention program.
    35    [(b) The commissioner, in consultation with the director of budget and
    36  the superintendent of financial services, shall  promulgate  regulations
    37  providing  public reimbursement for deductibles and copayments which are
    38  imposed under an insurance policy or health benefit plan to  the  extent
    39  that  such  deductibles  and  copayments  are applicable to early inter-
    40  vention services.
    41    (c) Payments made for early intervention services under  an  insurance
    42  policy  or  health  benefit plan, including payments made by the medical
    43  assistance program or other governmental third party  payor,  which  are
    44  provided  as  part  of  an  IFSP pursuant to section twenty-five hundred
    45  forty-five of this title shall not be applied by  the  insurer  or  plan
    46  administrator against any maximum lifetime or annual limits specified in
    47  the  policy  or  health benefits plan, pursuant to section eleven of the
    48  chapter of the laws of nineteen  hundred  ninety-two  which  added  this
    49  title.
    50    (d)]  (c)  A  municipality,  or  its designee, and a provider shall be
    51  subrogated, to the extent of the expenditures by  such  municipality  or
    52  for  early intervention services furnished to persons eligible for bene-
    53  fits under this title, to any rights such person may have or be entitled
    54  to from [third party reimbursement] the medical assistance program.  The
    55  provider shall submit notice to the insurer or plan administrator of his
    56  or her exercise of such right of subrogation upon the provider's assign-

        A. 356                              4
     1  ment as the early intervention service provider for the child. The right
     2  of  subrogation  does not attach to benefits paid or provided [under any
     3  health insurance policy or health benefits plan]  prior  to  receipt  of
     4  written  notice of the exercise of subrogation rights [by the insurer or
     5  plan administrator providing such benefits]. Notwithstanding any  incon-
     6  sistent provision of this title, except as provided for herein, no third
     7  party  payor other than the medical assistance program shall be required
     8  to reimburse for early intervention services provided under this title.
     9    § 8. Subdivision 3 of  section  2543  of  the  public  health  law  is
    10  REPEALED.
    11    § 9. Section 3235-a of the insurance law is REPEALED.
    12    §  10.  Subparagraph  (F) of paragraph 25 of subsection (i) of section
    13  3216 of the insurance law is REPEALED.
    14    § 11. Subparagraph (F) of paragraph 17 of subsection  (1)  of  section
    15  3221 of the insurance law is REPEALED.
    16    §  12. Paragraph 6 of subsection (ee) of section 4303 of the insurance
    17  law is REPEALED.
    18    § 13. This act shall take effect January 1, 2020;  provided,  however,
    19  that  the  amendments to section 2807-s of the public health law made by
    20  sections two and three of this act shall not affect  the  expiration  of
    21  such  section  and  shall be deemed to expire therewith. Effective imme-
    22  diately, the addition, amendment and/or repeal of any rule or regulation
    23  necessary for the implementation of this act on its effective  date  are
    24  authorized to be made and completed by the commissioner of health, on or
    25  before such effective date.