Relates to financial responsibility and reimbursement for payment for early intervention services.
TITLE OF BILL: An act to amend the public health law, in relation to financial responsibility and reimbursement for payment for early intervention services
This bill amends 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, and 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, to require the state of New York or its fiscal agent to collect payment from third party payors in the Early Intervention Program, and to make payment in full on proper claims submitted by providers within 30 days.
SUMMARY OF PROVISIONS:
Section 1 of the bill amends 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, by requiring, the state of New York, or its designated fiscal agent, to seek payment in the first instance from all third party payors in the early intervention program.
Section 2 of the bill directs payment to be made within 30 days of the date on which the municipality pays the claim for the approved costs of Early Intervention Services. It also clarifies that the net costs of Early Intervention Services are to be borne equally by the state and counties.
Section 3 of the bill requires the fiscal agent to do at least quarterly reconciliations of health insurance and Medicaid reimbursement, and provide refunds to the state and counties in equal shares.
Section 4 of the bill makes the bill to be effective immediately, and includes a provision that the act is deemed to be in full force and effect on or after June 1, 2014.
In 2012, changes were made to the funding of Early Intervention Services, particularly in the provision of occupational, speech and other provider directed therapies. The purpose of the changes was to ensure that NYS was receiving the full benefit of, and cost reductions appurtenant to, third party insurance reimbursement for covered services.
Under existing law, payment for the services rendered are delayed for an extended period of time, and only reimbursed initially up to 50%. Providers of these services, were, for the first time, required to obtain insurance reimbursement themselves.
Prior to the 2012 statutory changes, local government units were responsible for the collection of third party payments from health insurance companies and Medicaid for the appropriate share of the
reimbursable costs of those services. At no time prior to the enactment of this legislation were the providers required to collect these third party payments.
By changing the law, the statute has shifted the onerous and time consuming burden to the providers, many of whom are sole proprietorships. They do not have the requisite staff or systems required for coding, document submission or appeals that are part of the third party payment system.
As a result, many of the providers are unable to fulfill this new mandate, and large numbers have received no payments for services rendered since April 2013. The ability to provide early intervention services to children across the state is in jeopardy.
This legislation would require the state, or its fiscal agent, to pursue these funds, removing the unfunded mandate from local entities providing these early intervention health care services. Recognizing that the goal of the original statute was to capture third party payment and reduce the state's financial burden, the state or the fiscal agent is the appropriate entity to pursue this reimbursement.
Upon obtaining, third party payment from the insurers, the law would further require the fiscal agent to complete a reconciliation of reimbursements, and provide payment back to the state and counties in equal shares.
This legislation provides for more timely payment of the claims submitted by contracted providers, yet maintains the requirement that the providers and counties assist the state or the fiscal agent with the efforts to recoup the funds from the third party payors.
It also deems the new law to be in full force and effect as of June 1, 2014, so that payments can be made to providers for services rendered at that time.
2013: 5938A -- RULES
This act shall take effect immediately; provided that the new provisions of paragraph (a) of subdivision 3 of section 2559 of the public health law, and subdivision 1 of section 2557 of the public health law, shall be deemed to have been in full force and effect on or after June 1, 2014.
STATE OF NEW YORK ________________________________________________________________________ 5938--B 2013-2014 Regular Sessions IN SENATE September 20, 2013 ___________Introduced by Sens. TKACZYK, ADDABBO, AVELLA, BRESLIN, GIPSON, LATIMER, PARKER -- read twice and ordered printed, and when printed to be committed to the Committee on Rules -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee -- recommitted to the Committee on Health in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to financial respon- sibility and reimbursement for payment for early intervention services THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. 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. S 2. 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 STATEEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11760-08-4 S. 5938--B 2
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]WITHIN THIRTY DAYS by the appropriate governing body or offi- cer of the municipality AND THE STATE upon vouchers presented and audit- ed in the same manner as the case of other claims against the munici- pality. 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 govern- ment 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 3. Subdivision 5 of section 2557 of the public health law is amended by adding a new paragraph (d) to read as follows: (D) THE FISCAL AGENT SHALL, AT LEAST QUARTERLY, CONDUCT A RECONCIL- IATION OF THIRD PARTY REIMBURSEMENT PURSUANT TO SUBDIVISION THREE OF SECTION TWENTY-FIVE HUNDRED FIFTY-NINE OF THIS ARTICLE, AND PROVIDE REIMBURSEMENT IN EQUAL PROPORTION TO THE STATE AND MUNICIPALITY UPON VOUCHERS FOR EARLY INTERVENTION SERVICES THAT HAVE BEEN PAID. S 4. This act shall take effect immediately and shall be deemed to have been in full force and effect on and after June 1, 2014.