BILL NUMBER:S1946

TITLE OF BILL:

An act to amend the insurance law, in relation to coverage of early
intervention services

PURPOSE:

To amend the insurance law to ensure recoupment from commercial
insurers for the cost of the early intervention program.

SUMMARY OF PROVISIONS:

Section one amends subsection (a) of section 3235-a of the insurance
law, as added by section 3 of part C of chapter 1 of the laws of 2002,
to prohibit accident and health insurance policies from excluding from
coverage services provided under title two-A of article twenty-five of
the public health law. Section one also amends section 3235-a to add
two new subsections (e) and (f). New subsection (e) provides that
where a service provided to an insured under the early intervention
program is a covered service under the insurer's policy, the
individualized family services plan, upon certification by the early
intervention official, shall be deemed to meet any Precertification,
preauthorization and medical necessity requirements imposed on
benefits under the policy. The early intervention official shall
              

remove or redact any information contained in the individualized
family services plan that is not required by the insurer for payment
purposes. Payment of a service covered under the insurance policy
shall be at rates established by the Commissioner of Health for such
service pursuant to regulations. New subsection (f) provides that no
insurer, including a health maintenance organization, shall deny
payment of an early intervention claim based on the location where
services are provided, the duration of the child's condition and/or
that the child's condition is not likely to significantly improve
within the time specified in the policy, or that the provider is not a
network or participating provider.

Section two provides the effective date.

JUSTIFICATION:

Although public and private commercial insurance is required by law to
be maximized in financing early intervention (EI) services,
reimbursement from third party payers, other than Medicaid, have been
minimal leaving the cost of this entitlement to be paid by state and
municipal tax dollars.

In recognition of the need to improve recoupment of insurance monies
to help pay for EI, the Third Party Reimbursement Task Force of the
New York State Early Invention Coordinating Council was convened in
1999. That Task Force examined data on billing and recoupment and
found that private insurance collection was at a low rate of 9%. An
updated survey conducted by the New York State Association of County
Health Officials of billing and recoupment in 2000 found that, while,
the amount billed to insurers had almost doubled, the recoupment rate
remained a low 11%.


The Task Force also consulted with experts from Massachusetts, Indiana
and Virginia, all states that have included in state law the specific
requirements necessary to ensure insurance payments for EI. Experts
from these three states indicated that requiring insurers to pay for
EI services minimally impacted insurance premiums and that insurers
may in fact have saved money in the long run due to the therapeutic
interventions under EI. Experts from the three states confirmed the
Task Force's finding that the single most important factor to improve
collections as well as reducing administrative burdens was legislation
requiring private commercial insurers to pay for EI.

Current insurance law does not include the necessary language to
insure that payments are made nor does the language preclude the
majority of reasons given for FT denials. As a result, it is necessary
that specific language be adopted to fix this problem.

LEGISLATIVE HISTORY:

S. 4991/A. 2401 - Insurance Committee.

FISCAL IMPLICATIONS:

None to the state, savings for municipalities.

EFFECTIVE DATE:

Immediate.