S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2569
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 20, 2017
                                ___________
 
 Introduced  by M. of A. PAULIN, GOTTFRIED, CAHILL, COOK, GALEF, GUNTHER,
   JAFFEE, LIFTON,  MAGNARELLI,  DINOWITZ,  BENEDETTO,  LUPARDO,  TITONE,
   ABINANTI, CROUCH -- read once and referred to the Committee on Health
 
 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:
   § 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01073-01-7

 A. 2569                             2
 
 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.
   §  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  EIGHTEEN  SHALL
 BE ONE HUNDRED FIFTEEN 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.
   § 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:  ONE HUNDRED  FIFTEEN  MILLION
 DOLLARS  FOR  THE  PERIOD  JANUARY  FIRST, TWO THOUSAND EIGHTEEN THROUGH
 DECEMBER THIRTY-FIRST, TWO THOUSAND EIGHTEEN.
   § 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.]
   §  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;

 A. 2569                             3
 
   (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  INDEPENDENT
 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
 EIGHTEEN  TO  DECEMBER THIRTY-FIRST, TWO THOUSAND EIGHTEEN, 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.
   §  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.
   § 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.
   § 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

 A. 2569                             4
 
 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:
   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.
   § 9.  This act shall take effect on the thirtieth day after  it  shall
 have become a law; provided, however the amendments to section 2807-s of

 A. 2569                             5
 
 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.