Requires the fiscal agent of the department of health to seek payments from third party payors, to providers of evaluations and early interventions services provided to children.
Ayes (59): Adams, Addabbo, Alesi, Avella, Ball, Bonacic, Breslin, Carlucci, DeFrancisco, Diaz, Dilan, Duane, Espaillat, Flanagan, Fuschillo, Gallivan, Gianaris, Golden, Griffo, Grisanti, Hannon, Hassell-Thomps, Johnson, Kennedy, Klein, Krueger, Lanza, Larkin, LaValle, Libous, Little, Marcellino, Martins, Maziarz, McDonald, Montgomery, Nozzolio, O'Mara, Oppenheimer, Parker, Peralta, Perkins, Ranzenhofer, Ritchie, Rivera, Robach, Saland, Sampson, Savino, Serrano, Seward, Skelos, Squadron, Stavisky, Stewart-Cousin, Storobin, Valesky, Young, Zeldin
Excused (3): Farley, Huntley, Smith
TITLE OF BILL:
An act to amend the public health law, in relation to payments to providers of evaluations and early intervention services to children
To make technical, clarifying amendments to provision adopted in the 2012-13 budget relating to the use of a fiscal agent in the Early Intervention Services Program.
SUMMARY OF PROVISIONS: Section 1 of the bill amends paragraph (a) of subdivision 3 of Section 2559 of the public health law to clarify that Early Intervention provides are not required to seek payment from third party payers but instead shall submit all claims through the fiscal agent who shall seek payment.
Section 2 of the bill provides the effective date.
JUSTIFICATION: This bill makes technical clarifying amendments to provisions adopted in the 2012-13 budget to ensure that EI provides are not required to directly bill third party venders and local governments. The intent of creating a fiscal agent was to have all bills funnel through one entity responsible for seeking reimbursement from third party insurance so that the process is more efficient and effective than having each county seeking payments as has been the practice under the EI program.
This bill merely makes the technical changes to clarify the intent of recently adopted budget language.
LEGISLATIVE HISTORY: New bill.
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: This act shall take effect on the same date and in the same manner as section 11 of part A of chapter 56 of the laws of 2012, takes effect.
STATE OF NEW YORK ________________________________________________________________________ 7161 IN SENATE May 1, 2012 ___________Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law, in relation to payments to providers of evaluations and early intervention services to children THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. 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: (a) Providers of evaluations and early intervention services, herein- after 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 prior to claiming payment from a given municipality]SUBMIT ALL CLAIMS for evaluations conducted under the program and for services rendered to eligible children [, provided that, the]THROUGH THE FISCAL AGENT. THE FISCAL AGENT SHALL BE RESPONSIBLE FOR SEEKING PAYMENT FROM ALL THIRD PARTY PAYORS, INCLUDING GOVERNMENTAL AGENCIES. 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 policy. (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]SUBMISSION OF CLAIMS FOR PAYMENT, INCLUD- ING THIRD PARTY PAYORS, for evaluations and services rendered under the early intervention program. S 2. This act shall take effect on the same date and in the same manner as section 11 of part A of chapter 56 of the laws of 2012, takes effect.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD15556-02-2