S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  8316

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            December 18, 2013
                               ___________

Introduced  by M. of A. GOTTFRIED, CAHILL, HEVESI, ABINANTI, BRAUNSTEIN,
  BRONSON, BUCHWALD, FAHY,  JACOBS,  JAFFEE,  LUPARDO,  MARKEY,  MILLER,
  MILLMAN,  O'DONNELL,  OTIS,  PAULIN,  RAIA,  ROBERTS,  ROSA,  SCHIMEL,
  SEPULVEDA, SKARTADOS, SKOUFIS, STECK, STIRPE, SWEENEY, THIELE, WEISEN-
  BERG, ZEBROWSKI, SCARBOROUGH, ROSENTHAL -- Multi-Sponsored by -- M. of
  A. HEASTIE, MAYER, RODRIGUEZ, SIMANOWITZ, TITONE, WALTER -- read  once
  and referred to the Committee on Health

AN  ACT  to  amend  the  public health law, in relation to the financial
  responsibility for and reimbursement of payment for early intervention
  services by the state

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Subdivision 1 of section 2557 of the public health law, as
amended by section 4 of part C of chapter 1 of  the  laws  of  2002,  is
amended to read as follows:
  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 AND THE STATE
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 FULL AT  THE  STATE  APPROVED  EARLY
INTERVENTION  RATE  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] BY THE STATE OR ITS DESIGNATED FISCAL AGENT TO
A PROVIDER WITHIN THIRTY DAYS OF THE RECEIPT BY THE STATE OR ITS  DESIG-
NATED  STATE  FISCAL AGENT OF AN INITIAL CLAIM FROM A PROVIDER.  WHERE A
PROVIDER'S ASSIGNMENT IS CALLED FOR UNDER PARAGRAPH (D)  OF  SUBDIVISION
THREE  OF  SECTION  TWENTY-FIVE  HUNDRED  FIFTY-NINE  OF THIS TITLE, THE
ASSIGNMENT SHALL BE PART OF THE PROVIDER'S CLAIM.   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

              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13146-02-3

A. 8316                             2

title. Notwithstanding the insurance law or any other law  or  agreement
to the contrary, benefits under this title shall be considered secondary
to any plan of insurance or state government benefit program under which
an  eligible  child  may  have  coverage.  Nothing in this section shall
increase or enhance coverages provided for within an insurance  contract
subject to the provisions of this title.
  S  2.    The  opening  paragraph  of paragraph (a) of subdivision 3 of
section 2559 of the public health law, as amended by section 11 of  part
A of chapter 56 of the laws of 2012, is amended to read as follows:
  [Providers of evaluations and early intervention services, hereinafter
collectively  referred  to in this subdivision as "provider" or "provid-
ers",] THE STATE OR ITS DESIGNATED FISCAL  AGENT  shall  [in  the  first
instance  and],  where  applicable,  seek  payment  from all third party
payors including governmental agencies [prior to claiming payment from a
given municipality] for evaluations conducted under the program and  for
services rendered to eligible children, provided that, the obligation to
seek  payment  shall not apply to a payment from a third party payor who
is not prohibited from  applying  such  payment,  and  will  apply  such
payment, to an annual or lifetime limit specified in the insured's poli-
cy.    THE STATE OR ITS DESIGNATED FISCAL AGENT SHALL BE RESPONSIBLE FOR
FILING AND CONDUCTING ALL APPEALS OF PAYMENT DENIALS BY ALL THIRD  PARTY
PAYORS INCLUDING GOVERNMENTAL AGENCIES, AND TRACKING CLAIMS SUBMITTED TO
ALL THIRD PARTY PAYORS INCLUDING GOVERNMENTAL AGENCIES.
  S  3.  Paragraph  (a)  of  subdivision 3 of section 2559 of the public
health law is amended by adding a  new  subparagraph  (iv)  to  read  as
follows:
  (IV)  THE  FISCAL AGENT SHALL, AT LEAST QUARTERLY, CONDUCT A RECONCIL-
IATION OF THIRD PARTY REIMBURSEMENT PURSUANT  TO  THIS  SUBDIVISION  AND
PROVIDE  REIMBURSEMENT  AT  LEVELS  IN ACCORDANCE WITH THIS TITLE TO THE
STATE AND MUNICIPALITIES.
  S 4. Paragraph (d) of subdivision 3 of  section  2559  of  the  public
health law, as amended by section 11 of part A of chapter 56 of the laws
of 2012, is amended to read as follows:
  (d) A municipality, or its designee, and [a provider] THE STATE OR ITS
DESIGNATED  FISCAL  AGENT  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  third  party
reimbursement. The [provider] STATE OR ITS DESIGNATED FISCAL AGENT shall
submit  notice  to the insurer or plan administrator of [his or her] ITS
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 under any
health insurance policy or health benefits  plan  prior  to  receipt  of
written  notice  of the exercise of subrogation rights by the insurer or
plan administrator providing such benefits.
  S 5. This act shall take effect on the sixtieth  day  after  it  shall
have  become  a  law,  and (a) shall apply to any claim for payment by a
provider for services under title 2-A of article 25 of the public health
law that has not been fully paid pursuant to such title on or after such
effective date, whether filed before or after the effective date of this
act and (b) effective immediately, the commissioner of health is author-
ized and directed to promulgate regulations and take all actions  neces-
sary  and  appropriate  to  implement  the provisions of this act on its
effective date.

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 8316--A

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            December 18, 2013
                               ___________

Introduced  by M. of A. GOTTFRIED, CAHILL, HEVESI, ABINANTI, BRAUNSTEIN,
  BRONSON, BUCHWALD, FAHY,  JACOBS,  JAFFEE,  LUPARDO,  MARKEY,  MILLER,
  MILLMAN,  O'DONNELL,  OTIS,  PAULIN,  RAIA,  ROBERTS,  ROSA,  SCHIMEL,
  SEPULVEDA, SKARTADOS, SKOUFIS, STECK, STIRPE, SWEENEY, THIELE, WEISEN-
  BERG, ZEBROWSKI, SCARBOROUGH, ROSENTHAL, COOK, GUNTHER, LIFTON,  BENE-
  DETTO, WEPRIN, ROZIC, GALEF, CLARK, TITONE, ROBINSON, RUSSELL, CUSICK,
  SALADINO,  LAVINE,  COLTON, BARRETT, BROOK-KRASNY, McDONALD, BRINDISI,
  GOODELL, MAGNARELLI -- Multi-Sponsored by -- M. of A. ARROYO, BRENNAN,
  CROUCH, DUPREY, HEASTIE,  KEARNS,  LUPINACCI,  MAYER,  McDONOUGH,  RA,
  RODRIGUEZ, SIMANOWITZ, WALTER, WRIGHT -- read once and referred to the
  Committee  on  Health  --  recommitted  to  the Committee on Health in
  accordance with Assembly Rule 3, sec. 2 -- reported  and  referred  to
  the Committee on Ways and Means -- committee discharged, bill amended,
  ordered reprinted as amended and recommitted to said committee

AN  ACT to amend the public health law, the insurance law and chapter 60
  of the laws of  2014  amending  the  public  health  law  relating  to
  payments  submitted  by  early intervention providers to certain third
  party payors, in relation to  the  financial  responsibility  for  and
  reimbursement of payment for early intervention services by the state

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subdivision 1 of section 2557 of the public health law,  as
amended  by  section  4  of  part C of chapter 1 of the laws of 2002, is
amended to read as follows:
  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  eligi-
ble  children who are also eligible for medical assistance. All approved
costs shall be paid IN FULL AT THE  STATE  APPROVED  EARLY  INTERVENTION

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13146-08-4
              

A. 8316--A                          2

RATE  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]  BY  THE STATE OR ITS DESIGNATED FISCAL AGENT ON BEHALF OF
THE MUNICIPALITY UPON SUBMISSION OF A CLAIM BY A PROVIDER OTHER  THAN  A
CLAIM  FOR MEDICAL ASSISTANCE.  THE STATE OR ITS DESIGNATED FISCAL AGENT
SHALL NOTIFY A PROVIDER IN  WRITING  WITHIN  FIFTEEN  BUSINESS  DAYS  OF
SUBMISSION  OF  ANY  CLAIM  OF  ALL SPECIFIC DEFECTS OR DISPUTES OF SUCH
CLAIM AND SPECIFICALLY REQUEST IN WRITING THE ADDITIONAL INFORMATION  OR
REMEDY NEEDED TO PROCESS FOR PAYMENT ANY DISPUTED PORTIONS OF THE CLAIM.
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 any plan of insurance or state government  bene-
fit  program under which an eligible child may have coverage. Nothing in
this section shall increase or enhance coverages provided for within  an
insurance contract subject to the provisions of this title.
  S  2.    The  opening  paragraph  of paragraph (a) of subdivision 5 of
section 2557 of the public health law is designated subparagraph (i) and
a new subparagraph (ii) is added to read as follows:
  (II) THE FISCAL AGENT'S DUTIES SHALL INCLUDE, BUT NOT BE  LIMITED  TO,
THE FOLLOWING:
  (1)  COLLABORATING  WITH  PROVIDERS TO PROCESS PAYABLE CLAIMS WITH ALL
THIRD PARTY PAYORS, INCLUDING BUT NOT LIMITED TO, OVERSEEING AND FACILI-
TATING THE RESUBMISSION OF CLAIMS  WHEN  FURTHER  INFORMATION  HAS  BEEN
REQUESTED BY SUCH THIRD PARTY PAYOR;
  (2) FACILITATING THE SUBMISSION OF SUBROGATION NOTICES BY THE PROVIDER
TO THIRD PARTY PAYORS;
  (3)  PROCESSING  AND  TRANSMITTING  CLAIMS  FROM THE DEPARTMENT'S DATA
SYSTEM FOR SERVICES THAT MAY BE COVERED BY A THIRD PARTY PAYOR; AND
  (4) ISSUING PAYMENT TO PROVIDERS FOR SERVICES NOT COVERED BY  A  THIRD
PARTY PAYOR IN ACCORDANCE WITH THIS TITLE.
  S  3.  Paragraph  (a)  of  subdivision 3 of section 2559 of the public
health law is amended by adding a  new  subparagraph  (iv)  to  read  as
follows:
  (IV)  THE  FISCAL AGENT SHALL, AT LEAST QUARTERLY, CONDUCT A RECONCIL-
IATION OF THIRD PARTY REIMBURSEMENT PURSUANT  TO  THIS  SUBDIVISION  AND
PROVIDE  REIMBURSEMENT  AT  LEVELS  IN ACCORDANCE WITH THIS TITLE TO THE
STATE AND MUNICIPALITIES.
  S 4. Section 2559 of the public health law is amended by adding a  new
subdivision 3-a to read as follows:
  3-A.  COMMENCING  ON AND AFTER THE EFFECTIVE DATE OF THIS SUBDIVISION,
ONLY FOR THOSE THIRD PARTY PAYORS WHO ARE NOT SUBJECT TO THE  PROVISIONS
OF  SECTION  THREE  THOUSAND  TWO HUNDRED THIRTY-FIVE-A OF THE INSURANCE
LAW, IF A PARENT PROVIDES CONSENT TO  ACCESS  COVERAGE  AVAILABLE  UNDER
SUCH  THIRD PARTY PAYOR AND THE THIRD PARTY PAYOR HAS NOT, WITHIN NINETY
DAYS OF THE INITIAL SUBMISSION OF SAID CLAIM, MADE PAYMENT OF THE  CLAIM
IN WHOLE OR IN PART OR RENDERED A DETERMINATION THAT IT IS NOT OBLIGATED
TO  PAY  THE  CLAIM, THE PROVIDER SHALL BE AUTHORIZED TO SEEK PAYMENT OF
SUCH CLAIM  FROM  THE  MUNICIPALITY,  THROUGH  THE  FISCAL  AGENT  UNDER
CONTRACT WITH THE DEPARTMENT. IF SUCH THIRD PARTY PAYOR MAKES PAYMENT OF
THE  CLAIM AFTER THE PROVIDER HAS RECEIVED PAYMENT FROM THE MUNICIPALITY
THROUGH THE FISCAL AGENT, THE THIRD PARTY PAYMENT  SHALL  BE  RECONCILED
AGAINST FUTURE PAYMENTS DUE TO THE PROVIDER FROM THE MUNICIPALITY.

A. 8316--A                          3

  S  5.    Subsection  (c)  of  section  3235-a of the insurance law, as
amended by section 17 of part A of chapter 56 of the laws  of  2012,  is
amended to read as follows:
  (c)  Any  right  of  subrogation  to  benefits which a municipality or
provider is entitled in accordance with  paragraph  (d)  of  subdivision
three of section twenty-five hundred fifty-nine of the public health law
shall  be  valid  and  enforceable  to the extent benefits are available
under any accident and health insurance policy. The right of subrogation
does not attach to insurance benefits paid or provided under  any  acci-
dent  and  health  insurance  policy  prior to receipt by the insurer of
written notice from the municipality or provider, as applicable.  IF  AN
INSURER  MAKES  PAYMENT  IN  WHOLE  OR  IN  PART FOR A CLAIM OR BILL FOR
SERVICES RENDERED UNDER THE EARLY INTERVENTION  PROGRAM  ESTABLISHED  IN
TITLE  TWO-A  OF  ARTICLE  TWENTY-FIVE  OF  THE  PUBLIC HEALTH LAW, SUCH
PAYMENT SHALL BE MADE TO THE PROVIDER WHO SUBMITTED THE CLAIM AND NOT TO
THE COVERED PERSON REGARDLESS OF WHETHER SUCH PROVIDER IS IN THE  INSUR-
ER'S  NETWORK,  AND  A  REMITTANCE  ADVICE  SHALL  BE TRANSMITTED TO THE
DEPARTMENT OF  HEALTH'S  DESIGNATED  FISCAL  AGENT.  The  insurer  shall
provide the municipality and service coordinator with information on the
extent  of  benefits  available  to the covered person under such policy
within fifteen days of the insurer's  receipt  of  written  request  and
notice  authorizing  such release. The service coordinator shall provide
such information to the rendering provider assigned to provide  services
to the child.
  S  6. Paragraph 2 of subsection (d) of section 3224-a of the insurance
law, as amended by section 57-b of part A of chapter 56 of the  laws  of
2013, is amended to read as follows:
  (2)  "health care provider" shall mean an entity licensed or certified
pursuant to article twenty-eight, thirty-six  or  forty  of  the  public
health  law, a facility licensed pursuant to article nineteen or thirty-
one of the mental hygiene law, a  fiscal  intermediary  operating  under
section  three hundred sixty five-f of the social services law, AN INDI-
VIDUAL OR AGENCY APPROVED BY THE DEPARTMENT OF HEALTH PURSUANT TO  TITLE
TWO-A  OF  ARTICLE  TWENTY-FIVE  OF THE PUBLIC HEALTH LAW, a health care
professional licensed, registered or certified pursuant to  title  eight
of  the  education  law,  a  dispenser  or  provider  of  pharmaceutical
products, services or durable medical  equipment,  or  a  representative
designated by such entity or person.
  S  7.  Section 19 of part A of chapter 60 of the laws of 2014 amending
the public health law relating to payments  submitted  by  early  inter-
vention  providers  to  certain third party payors is amended to read as
follows:
  S 19. For claims for payment submitted by early intervention providers
to third party payors between the period April 1, 2013  until  June  30,
2013  in  accordance  with  title 2-A of article 25 of the public health
law, for which the third party payor has not, on the effective  date  of
this  section, made payment of the claim in whole or in part or rendered
a determination that it is not obligated to pay the claim, the  provider
shall be authorized to seek payment of such claim from the municipality,
through  the  fiscal agent under contract with the department of health;
provided, however, that  the  provider  shall  continue  to  render  any
assistance   needed,  and  provide  any  information  and  documentation
requested by the third party payor to facilitate payment  of  the  claim
even if the provider has already received payment from the municipality.
If  such third party payor makes payment of the claim after the provider
has received payment from the  municipality,  the  third  party  payment

A. 8316--A                          4

shall  be  reconciled  against future payments due the provider from the
municipality. This section shall  only  apply  to  claims  submitted  by
approved  early  intervention providers to third party payors during the
period  April 1, 2013 until June 30, 2013 for which no payment or deter-
mination has been made, as specified in this section, on April 1,  2014.
PROVIDED,  HOWEVER, IN THE EVENT THAT FUNDS APPROPRIATED FOR THE PURPOSE
OF THIS SECTION EXCEED THE AMOUNTS NECESSARY TO PAY STATE  REIMBURSEMENT
TO  MUNICIPALITIES FOR SUCH CLAIMS, THE PERIOD SET FORTH HEREIN SHALL BE
EXPANDED, AS DETERMINED BY THE  DEPARTMENT  OF  HEALTH  SUBJECT  TO  THE
AVAILABILITY  OF  FUNDING,  TO INCLUDE ADDITIONAL CLAIMS SUBMITTED ON OR
AFTER APRIL 1, 2013 BY  EARLY  INTERVENTION  PROVIDERS  TO  THIRD  PARTY
PAYORS FOR WHICH THE THIRD PARTY PAYOR HAS NOT, ON THE EFFECTIVE DATE OF
THIS  SECTION, MADE PAYMENT OF THE CLAIM IN WHOLE OR IN PART OR RENDERED
A DETERMINATION THAT IT IS NOT OBLIGATED TO PAY  SUCH  CLAIM;  PROVIDED,
FURTHER  THAT  ALL  OTHER PROVISIONS OF THIS SECTION SHALL APPLY TO SUCH
CLAIMS TO BE PAID BY A MUNICIPALITY IN  ACCORDANCE  WITH  THIS  SECTION.
Payment  shall  be made on the forty-fifth day after this act shall take
effect. The provisions in subdivision 2 of section 2557  of  the  public
health  law  that  prohibit state reimbursement from being paid prior to
April first of the year in which the approved  costs  are  paid  by  the
municipality  shall  not apply to the municipal payments made under this
section.
  S 8. This act shall take effect January 1, 2015, and  shall  apply  to
all  claims  for  payment,  other  than  claims  for medical assistance,
submitted by an early intervention provider to third party payors  after
June  30,  2013;  provided,  however, that the commissioner of health is
authorized and directed to promulgate regulations and take  all  actions
necessary and appropriate to implement the provisions of this act on its
effective date.