Provides for state grant funding to municipalities for early intervention services for toddlers with disabilities and their families.
TITLE OF BILL: An act to amend the public health law, in relation to funding early intervention services
To provide a system that streamlines the process by which funds are distributed to municipalities to finance early intervention programs, thereby providing vital relief to the municipalities across the state, and to improve their ability to more effectively administer early intervention services to children who need such services.
SUMMARY OF PROVISIONS:
Section one amends the public health law by adding a new section 2807-o that provides definitions for terms used in this section of law. Section one also provides that the commissioner of health shall make grants to municipalities for the delivery of early intervention services. Such grants shall be deemed reimbursements from third party payors to the municipalities and the State and shall be a share of grants equal to the proportionate share of the municipality and the State, as the case may be, of the total approved statewide dollars not reimbursable by the medical assistance program paid by municipalities and the State to providers of early intervention services in the last complete state fiscal year for which such data is available.
Section two amends subdivision 6 of section 2807-s of the public health law by adding two new paragraphs (g) and (h). Paragraph (g) provides that a further gross statewide amount for two thousand fourteen shall be four hundred million dollars. Paragraph (h) provides that the four hundred million dollars specified in paragraph (g) shall be allocated among the municipalities and the State based on the share of each municipality and the State of early intervention program expenditures not reimbursable by the medical assistance program for the latest twelve month period for which such data is available.
Section three amends subdivision 7 of section 2807-s of the public health law by adding a new paragraph (d) that provides that funds shall be added to the funds collected by the commissioner for distribution in accordance with section 2807-o, in the amount of four hundred million dollars for the period January 1, 2014 through December 31, 2014.
Section four amends subdivision 1 of section 2557 of the public health law, subdivision 1 as amended by section 4 of part C of chapter 1 of the laws of 2002, to delete the reference to a plan of insurance so that benefits under this title shall be considered secondary only to any state government benefit Program under which an eligible child may have coverage, and to delete the provision that nothing in this section shall increase or enhance coverages provided for within an insurance contract subject to the provisions of this title.
Section five amends section 2557 of the public health law by adding a new subdivision 4 to require the commissioner to collect data, by municipality, on the early intervention program for purposes of improving the efficiency, cost effectiveness and quality of the
program. Data to be collected shall include the number of children enrolled in the program, the number of state approved agencies and organizations providing early intervention services by service specialty and the number of state approved independent providers of early intervention services by service specialty, the number of state approved evaluators, the number of children covered by the medical assistance program, the number of claims submitted to the medical assistance program by municipality, the percentage claims denied by medical assistance and the reasons for the denials. The commissioner shall report for the period July 1, 2014 to December 31, 2014 and for each calendar year thereafter, to the Governor and the Legislature by March 1 of each year the information and analysis required by this section.
Section six amends subdivision 2 of section 2557 of the public health law, as amended by section 9-a of part A of chapter 56 of the laws of 2012, to provide that the department shall reimburse the approved costs paid by a municipality other than those reimbursable by the medical assistance program, eliminating the exclusion of costs reimbursable by third party payors.
Section seven amends the section heading of section 2559 of the public health law, as added by chapter 428 of the laws of 1992, to eliminate the reference to third party insurance.
Section eight amends subdivision 3 of section 2559 of the public health law, as added by chapter 428 of the laws of 1992, paragraphs (a), (c) and (d) as amended by section 11 of part A of chapter 56 of the laws of 2012 and paragraph b as further amended by section 104 of Part A of chapter 62 of the laws of 2011, to provide that providers shall first seek payment from the medical assistance program rather than third party payors including governmental agencies, prior to claiming payment from a municipality for services rendered, though not when the insured is not eligible for medical assistance pursuant to the social services law. Section eight also deletes paragraphs (b)requiring the commissioner to promulgate regulations providing public reimbursement for deductibles and copayments imposed under an insurance policy or health benefit plan to the extent that such deductibles and copayments are applicable to early intervention services and (c) requiring that payments made for early intervention services under an insurance policy or health benefit plan provided as part of an IFS? shall not be applied against any maxi- mum lifetime or annual limits specified in the policy or health benefits plan). In addition, section eight provides that a municipality shall be subrogated to the extent of its expenditures f or early intervention services furnished to eligible persons to the rights such person may have from the medical assistance program rather than from third party reimbursement. Except as provided in this article, no third party payor other than the medical assistance program shall be required to reimburse for early intervention services.
Section nine provides the effective date.
The early intervention program was established under the Public Health Law and the federal Individuals with Disabilities Education Act (IDEA)
to enhance the development of infants and toddlers from birth to age three who have a significant developmental delay or disability, as well as enhance the capacity of families to meet their children's special needs. The program seeks to identify and evaluate as early as possible those infants and toddlers whose healthy development is compromised and to provide for appropriate therapeutic and supportive services. With early intervention, we can reduce the number of children with disabilities or reduce the severity of their disabling conditions. All early intervention (EI) services must be provided to eligible children at no cost to their families. The HI program is financed through a combination of state and county funds, Medicaid and commercial insurance. Although Public Health Law and IDEA mandate that public and private commercial insurance be maximized in financing EI services, reimbursement from third party payors, other than Medicaid, has been minimal, leaving the cost of this entitlement to be paid by state and municipal tax dollars.
In 2005 an aggregate 893,000 claims were submitted to commercial insurers; 70% of the claims were denied. Further, according to a survey by the New York State Association of County Health Officials, for the period July 2003 to June 2004, $75.5 million in claims for EI services were filed with commercial insurers, of which $10.6 million, or 14%, was paid. Counties, which are required by the state to finance and administer the EI program, are entitled to be reimbursed by the state for 50% of their unreimbursed costs for Ed services (36% for administration costs). Counties have billed private insurers approximately $100 million, overshadowing the aggregate costs billed to Medicaid. The partial funding by the state, combined with the low rate of recoupment from third party insurers, has required municipalities to bear an estimated 43% of the costs of providing EI services.
To require municipalities to bear such a significant portion of the costs of the program where the number of children served as well as the level of services provided continues to increase imposes a significant strain on local budgets. In New York City alone, for the last six months of 2005, an estimated $213.1 million was incurred for EI services, of which $800,000 was paid by commercial insurance. Whereas in 1993 to 1994, the first year the EI program became effective, the costs of EI services for the entire state was $40 million. Since a substantial portion of municipal budgets must be spent on EI services, municipalities must face a shrinking balance of available funds, forcing them to decrease or eliminate altogether other needed services.
Recognizing that the current structure of financing EI costs is inadequate, this bill provides a different approach to funding. The bill would set up a statewide pool from which municipalities would be allocated funds to pay ET costs. By allowing for the direct allocation of funds to municipalities from the statewide pool, we will eliminate the unwieldy and inefficient step of requiring municipalities (in the case where the insured is not eligible for medical assistance) to seek reimbursement of EI costs first from third party insurers and then, only upon denial or other disposition of the claim, from the state. In cases where the insured is eligible for medical assistance, municipalities will remain obligated to seek reimbursement first from the medical assistance program.
Making funds readily available and streamlining the process by which the funds are distributed to municipalities will provide vital relief to the municipalities across the state that have been struggling to finance the
EI program and thereby improve their ability to more effectively administer EI services to children who need those services.
This is a new bill.
Approximately $100 million to the state.
This act shall take effect April 1, 2014.
STATE OF NEW YORK ________________________________________________________________________ 6001 2013-2014 Regular Sessions IN SENATE December 2, 2013 ___________Introduced by Sen. GIPSON -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the public health law, in relation to funding early intervention services THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The public health law is amended by adding a new section 2807-o to read as follows: S 2807-O. EARLY INTERVENTION SERVICES POOL. 1. DEFINITIONS. THE FOLLOWING WORDS OR PHRASES AS USED IN THIS SECTION SHALL HAVE THE FOLLOWING MEANINGS: (A) "EARLY INTERVENTION SERVICES" SHALL MEAN SERVICES DELIVERED TO AN ELIGIBLE CHILD, PURSUANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER THE EARLY INTERVENTION PROGRAM. (B) "EARLY INTERVENTION PROGRAM" SHALL MEAN THE EARLY INTERVENTION PROGRAM FOR TODDLERS WITH DISABILITIES AND THEIR FAMILIES AS CREATED BY TITLE TWO-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER. (C) "MUNICIPALITY" SHALL MEAN ANY COUNTY OUTSIDE OF THE CITY OF NEW YORK OR THE CITY OF NEW YORK. 2. GRANTS FOR EARLY INTERVENTION SERVICES. (A) THE COMMISSIONER SHALL, FROM FUNDS ALLOCATED FOR SUCH PURPOSE UNDER PARAGRAPH (G) OF SUBDIVISION SIX OF SECTION TWENTY-EIGHT HUNDRED SEVEN-S OF THIS ARTICLE, MAKE GRANTS TO MUNICIPALITIES FOR THE DELIVERY OF EARLY INTERVENTION SERVICES. SUCH GRANTS SHALL BE DEEMED REIMBURSEMENT FROM THIRD PARTY PAYORS TO SUCH MUNICIPALITIES AND THE STATE OF NEW YORK FOR THE PURPOSES OF THE EARLY INTERVENTION PROGRAM. (B) GRANTS UNDER THIS SUBDIVISION SHALL BE AWARDED TO MUNICIPALITIES BY THE COMMISSIONER. EACH MUNICIPALITY AND THE STATE OF NEW YORK SHALL RECEIVE A SHARE OF SUCH GRANTS EQUAL TO ITS PROPORTIONATE SHARE OF THE TOTAL APPROVED STATEWIDE DOLLARS NOT REIMBURSABLE BY THE MEDICAL ASSIST- ANCE PROGRAM PAID TO PROVIDERS OF EARLY INTERVENTION SERVICES BY THE STATE AND MUNICIPALITIES ON ACCOUNT OF EARLY INTERVENTION SERVICES IN THE LAST COMPLETE STATE FISCAL YEAR FOR WHICH SUCH DATA IS AVAILABLE.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD03039-02-3 S. 6001 2
S 2. Subdivision 6 of section 2807-s of the public health law is amended by adding two new paragraphs (g) and (h) to read as follows: (G) A FURTHER GROSS STATEWIDE AMOUNT FOR TWO THOUSAND FOURTEEN SHALL BE FOUR HUNDRED MILLION DOLLARS. (H) THE AMOUNT SPECIFIED IN PARAGRAPH (G) OF THIS SUBDIVISION SHALL BE ALLOCATED AMONG THE MUNICIPALITIES AND THE STATE OF NEW YORK BASED ON EACH MUNICIPALITY'S SHARE AND THE STATE'S SHARE OF EARLY INTERVENTION PROGRAM EXPENDITURES NOT REIMBURSABLE BY THE MEDICAL ASSISTANCE PROGRAM FOR THE LATEST TWELVE MONTH PERIOD FOR WHICH SUCH DATA IS AVAILABLE. S 3. Subdivision 7 of section 2807-s of the public health law is amended by adding a new paragraph (d) to read as follows: (D) FUNDS SHALL BE ADDED TO THE FUNDS COLLECTED BY THE COMMISSIONER FOR DISTRIBUTION IN ACCORDANCE WITH SECTION TWENTY-EIGHT HUNDRED SEVEN-O OF THIS ARTICLE, IN THE FOLLOWING AMOUNT: FOUR HUNDRED MILLION DOLLARS FOR THE PERIOD JANUARY FIRST, TWO THOUSAND FOURTEEN THROUGH DECEMBER THIRTY-FIRST, TWO THOUSAND FOURTEEN. S 4. 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 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. Notwithstanding the insurance law or regu- lations 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 benefit program under which an eligible child may have coverage. [Nothing in this section shall increase or enhance cover- ages provided for within an insurance contract subject to the provisions of this title.]S 5. Section 2557 of the public health law is amended by adding a new subdivision 4 to read as follows: 4. THE COMMISSIONER SHALL COLLECT DATA, BY MUNICIPALITY, ON THE EARLY INTERVENTION PROGRAM AUTHORIZED UNDER THIS TITLE FOR PURPOSES OF IMPROV- ING THE EFFICIENCY, COST EFFECTIVENESS, AND QUALITY OF SUCH PROGRAM. SUCH MUNICIPALITY DATA COLLECTION SHALL INCLUDE BUT NOT BE LIMITED TO: (A) THE NUMBER AND AGES OF CHILDREN ENROLLED IN THE EARLY INTERVENTION PROGRAM; (B) THE TOTAL NUMBER OF CHILDREN, WITHIN A MUNICIPALITY, RECEIVING A SINGLE SERVICE, THE PERCENTAGE OF THOSE CHILDREN BY SERVICE TYPE, AND THE AVERAGE FREQUENCY OF VISITS PER WEEK FOR SUCH SERVICE TYPE; (C) THE TOTAL NUMBER OF CHILDREN, WITHIN A MUNICIPALITY, RECEIVING MULTIPLE SERVICES, THE PERCENTAGE OF THOSE CHILDREN BY SERVICE TYPE, THE AVERAGE FREQUENCY OF VISITS PER WEEK FOR SUCH SERVICE TYPE AND THE AVER- AGE NUMBER OF SERVICE TYPES THAT EACH CHILD RECEIVES; (D) THE NUMBER OF NEW YORK STATE APPROVED AGENCIES, INSTITUTIONS, OR ORGANIZATIONS PROVIDING EARLY INTERVENTION SERVICES BY SERVICE SPECIALTY OR SPECIALTIES AND THE NUMBER OF NEW YORK STATE APPROVED INDEPENDENTS. 6001 3
PROVIDERS OF EARLY INTERVENTION SERVICES BY SERVICE SPECIALTY OR SPECIALTIES; (E) THE NUMBER AND PERCENTAGE OF CHILDREN RECEIVING A SINGLE SERVICE BY TYPE OF NEW YORK STATE APPROVED SERVICE PROVIDER, AND THE NUMBER AND PERCENTAGE OF CHILDREN RECEIVING MULTIPLE SERVICES BY TYPE OF NEW YORK STATE APPROVED SERVICE PROVIDER; (F) THE OVERALL NUMBER OF NEW YORK STATE APPROVED EVALUATORS. THE NUMBER OF APPROVED EVALUATORS WHO ALSO PROVIDE SERVICES TO EARLY INTER- VENTION CHILDREN THEY HAVE EVALUATED; (G) THE NUMBER OF FAMILIES RECEIVING FAMILY SUPPORTIVE SERVICES SUCH AS FAMILY TRAINING, COUNSELING, PARENT SUPPORT GROUPS, AND RESPITE; (H) THE TYPES OF CLINICAL PRACTICE GUIDELINES, EVALUATION TOOLS AND TESTING INSTRUMENTS USED BY MUNICIPALITIES TO ESTABLISH ELIGIBILITY OR NEED FOR EARLY INTERVENTION SERVICES; (I) BOTH SERVICE, COST AND PAYMENT OVERSIGHT MECHANISMS USED BY COUN- TIES TO ENSURE QUALITY AND EFFICIENT DELIVERY OF EARLY INTERVENTION SERVICES; (J) THE NUMBER OF CHILDREN THAT ARE COVERED BY THE MEDICAL ASSISTANCE PROGRAM; (K) THE NUMBER OF CLAIMS SUBMITTED TO THE MEDICAL ASSISTANCE PROGRAM BY MUNICIPALITY. THE PERCENTAGE OF CLAIMS DENIED BY THE MEDICAL ASSIST- ANCE PROGRAM. THE REASONS FOR THE DENIALS. THE COMMISSIONER SHALL COLLECT AND ANALYZE SUCH DATA ELEMENTS TO DETERMINE SERVICE AND UTILIZATION PATTERNS AND TO ENHANCE THE DEPART- MENT'S ONGOING PROVISION OF PROGRAM OVERSIGHT AND GUIDANCE. IN ADDITION, THE COMMISSIONER SHALL REPORT FOR THE PERIOD JULY FIRST, TWO THOUSAND FOURTEEN TO DECEMBER THIRTY-FIRST, TWO THOUSAND FOURTEEN, AND FOR EACH CALENDAR YEAR THEREAFTER, TO THE GOVERNOR AND THE LEGISLATURE, BY MARCH FIRST OF EACH YEAR, THE INFORMATION AND ANALYSIS REQUIRED BY THIS SUBDI- VISION. S 6. Subdivision 2 of section 2557 of the public health law, as amended by section 9-a of part A of chapter 56 of the laws of 2012, is amended to read as follows: 2. The department shall reimburse the approved costs paid by a munici- pality for the purposes of this title, other than those reimbursable by the medical assistance program
[or by third party payors], in an amount of fifty percent of the amount expended in accordance with the rules and regulations of the commissioner; provided, however, that in the discretion of the department and with the approval of the director of the division of the budget, the department may reimburse municipalities in an amount greater than fifty percent of the amount expended. Such state reimbursement to the municipality shall not be paid prior to April first of the year in which the approved costs are paid by the munici- pality, provided, however that, subject to the approval of the director of the budget, the department may pay such state aid reimbursement to the municipality prior to such date. S 7. The section heading of section 2559 of the public health law, as added by chapter 428 of the laws of 1992, is amended to read as follows: [Third party insurance and medical]MEDICAL assistance program payments. S 8. Subdivision 3 of section 2559 of the public health law, as added by chapter 428 of the laws of 1992, paragraphs (a), (c) and (d) as amended by section 11 of part A of chapter 56 of the laws of 2012 and paragraph (b) as further amended by section 104 of part A of chapter 62 of the laws of 2011, is amended to read as follows:S. 6001 4
3. (a) Providers of evaluations and early intervention services, here- inafter collectively referred to in this subdivision as "provider" or "providers", shall in the first instance and where applicable, seek payment from
[all third party payors including governmental agencies]THE MEDICAL ASSISTANCE PROGRAM 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]WHERE THE INSURED IS NOT ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO THE SOCIAL SERVICES LAW. (i) Parents shall provide the municipality and service coordinator information on any insurance policy, plan or contract under which an eligible child has coverage. (ii) Parents shall provide the municipality and the service coordina- tor with a written referral from a primary care provider as documenta- tion, for eligible children, of the medical necessity of early inter- vention services. (iii) providers shall utilize the department's fiscal agent and data system for claiming payment for evaluations and services rendered under the early intervention program. (b) [The commissioner, in consultation with the director of budget and the superintendent of financial services, shall promulgate regulations providing public reimbursement for deductibles and copayments which are imposed under an insurance policy or health benefit plan to the extent that such deductibles and copayments are applicable to early inter- vention services. (c) Payments made for early intervention services under an insurance policy or health benefit plan, including payments made by the medical assistance program or other governmental third party payor, which are provided as part of an IFSP pursuant to section twenty-five hundred forty-five of this title shall not be applied by the insurer or plan administrator against any maximum lifetime or annual limits specified in the policy or health benefits plan, pursuant to section eleven of the chapter of the laws of nineteen hundred ninety-two which added this title. (d)]A municipality, or its designee, and a provider shall be subro- gated, 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 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 assign- ment 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]. NOTWITHSTANDING ANY INCON- SISTENT 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. S 9. This act shall take effect April 1, 2014; provided, however the amendments to section 2807-s of the public health law made by sections two and three of this act shall not affect the expiration of such section and shall be deemed to expire therewith.