BILL NUMBER:S5544A

TITLE OF BILL:  An act to amend the mental hygiene law, in relation to
reimbursement of certain programs and services for persons with a
disability

PURPOSE: To ensure local service providers are reimbursed from the
Office for People with Developmental Disabilities, for the rendering
of approved services, while such approval is pending.

SUMMARY OF PROVISIONS:

Section 1 amends article 43 of the mental hygiene law related to fees
for service by adding a new section 43.13 to provide for the
reimbursement of a service furnished by a local service provider while
the commissioner approves the service, provided that such approval is
ultimately granted. This section also provides that if a service is
ultimately not approved and reimbursement has already occurred, such
reimbursement shall be returned to the Office for People with
Developmental Disabilities within sixty days of notice of such denial.

Section 2 provides the effective date.

EXISTING LAW:  Pursuant to § 13.13 of the Mental Hygiene Law, local
services for persons with developmental disabilities shall be planned,
financed, and implemented in accordance with the provisions of this
              

chapter.

Pursuant to § 13.13 of the Mental Hygiene Law, the Commissioner of the
Office for People with Developmental Disabilities shall plan, promote,
establish, develop, coordinate, evaluate, and conduct programs and
services of prevention, diagnosis, examination, care, treatment,
rehabilitation, training, and research for the benefit of individuals
with developmental disabilities. Such programs shall include, but are
not limited to, inpatient, outpatient, partial hospitalization, day
care, emergency, rehabilitative, and other appropriate treatments and
services. The commissioner shall take all actions necessary,
desirable, or proper to implement the purposes of this chapter, and to
carry out the purposes and objectives of the Office within the amounts
made available therefore by appropriation, grant, gift, devise,
bequest, or allocation from the Mental Health Service Fund established
under § 97-f of the Finance Law. The activities described here may be
undertaken in cooperation and agreement with other offices,
departments, or agencies of the state, local or federal government, or
with other organizations and individuals.

Pursuant to § 13.17(c) of the Mental Hygiene Law, the Commissioner of
the Office for People with Developmental Disabilities may authorize
other offices of the Department and any public or private non-profit
organization or political subdivision of the state to deliver supports
and services to individuals with development disabilities, not
inconsistent with the programs and objectives of the Office in any
facility under the commissioner's jurisdiction. The commissioner may
permit any facility under the commissioner's jurisdiction to operate
programs for persons with mental disabilities, not inconsistent with
programs and objectives of the Department, under contracts or
agreements with other offices within the Department.


JUSTIFICATION:  Services rendered to persons with developmental
disabilities by local service providers and agencies must be approved
the Office for Persons with Developmental Disabilities (OPWDD).
Generally, an individual, or a family member on the behalf of an
individual, will approach a local service provider seeking disability
services. That individual is then referred to OPWDD for an evaluative
process during which OPWDD will determine the services that are
available to the person and which centers provide the approved
services. A family may choose only from the services and centers
approved through OPWDD's assessment.

A local provider is proscribed from providing any service to a person
with a developmental disability until such service is approved by
OPWDD. Often, an initial placement in a particular program or the
rendering of specific services is inappropriate for the individual
requiring the service. This may result in extraordinary hardships for
both the individual and that person's caregivers, especially when the
inappropriate placement results in physical or emotional harm to the
individual, or when abridgement in service results in a lapse of day
care thus forcing the caregiver to modify his or her own employment
obligations. Furthermore, local service providers cannot help
facilitate the evaluation and approval process and are prevented from
advocating on behalf of their clients and families.

In an effort to offer the necessary services and treatments to all of
their clients in a streamlined and consistent manner, local service
providers often provide uncompensated care. But uncompensated care
does not mean that the services provided were not approved by OPWDD.
Rather, the uncompensated care may have been administered while the
individual was still being approved, or during an interim period when
OPWDD had not yet approved a more appropriate placement or treatment
for that person's particular needs.

This bill requires that if a person with developmental disabilities
qualifying for such a program and has entered into a program or
received a service furnished by a local service provider, and
subsequently enters into a different program or receives a different
service not yet approved by OPWDD, the local service provider must be
reimbursed the cost of that program or service as if it had been
approved prior to such person's admission to the program, provided
that such approval is ultimately granted by the Department. While only
those services that are ultimately approved by OPWDD quality for
reimbursement during the interim period, this bill will promote the
consistent delivery of necessary services to persons with
developmental disabilities and ensure local service providers are
appropriately compensated for the rendering of such approved services.
This legislation will foster the relationship between all of these
parties, including individuals with developmental disabilities and
their families, local service providers, and OPWDD.  As such it is
imperative that this bill is enacted.

LEGISLATIVE HISTORY: New Bill.

FISCAL IMPLICATIONS: Minimal.

EFFECTIVE DATE: This act shall take effect immediately.