S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5339
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 12, 2021
                                ___________
 
 Introduced  by M. of A. PAULIN, GOTTFRIED, CAHILL, COOK, GALEF, GUNTHER,
   MAGNARELLI, LUPARDO, DINOWITZ, BENEDETTO, ABINANTI --  read  once  and
   referred to the Committee on Health
 
 AN  ACT  to  amend  the  public health law, in relation to funding early
   intervention services; and to repeal certain provisions of the  public
   health law and the insurance law relating thereto
 
   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. PAYMENTS 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 PAYMENTS TO MUNICIPALITIES AND THE STATE FOR THE DELIVERY OF  EARLY
 INTERVENTION SERVICES.
   (B)  PAYMENTS  UNDER  THIS SUBDIVISION SHALL BE MADE TO MUNICIPALITIES
 AND THE STATE BY THE COMMISSIONER. EACH MUNICIPALITY AND  THE  STATE  OF
 NEW  YORK  SHALL  RECEIVE  A SHARE OF SUCH PAYMENTS EQUAL TO ITS PROPOR-
 TIONATE SHARE OF THE TOTAL APPROVED STATEWIDE DOLLARS  NOT  REIMBURSABLE
 BY  THE  MEDICAL  ASSISTANCE  PROGRAM  PAID TO PROVIDERS OF EARLY INTER-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01949-02-1

 A. 5339                             2
 
 VENTION 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 THE  STATE  FISCAL  YEAR  TWO
 THOUSAND TWENTY-TWO AND EACH STATE FISCAL YEAR THEREAFTER SHALL BE FORTY
 MILLION DOLLARS.
   (H) THE AMOUNT SPECIFIED IN PARAGRAPH (G) OF THIS SUBDIVISION SHALL BE
 ALLOCATED  UNDER  SECTION  TWENTY-EIGHT  HUNDRED SEVEN-O OF THIS ARTICLE
 AMONG THE MUNICIPALITIES AND THE STATE OF NEW YORK BASED ON EACH MUNICI-
 PALITY'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: FORTY MILLION DOLLARS FOR  THE
 PERIOD  BEGINNING  APRIL  FIRST, TWO THOUSAND TWENTY-TWO, AND CONTINUING
 EACH STATE FISCAL YEAR THEREAFTER.
   § 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] THE MEDICAL ASSISTANCE program under  which
 an  eligible  child  may  have  coverage. [Nothing in this section shall
 increase or enhance coverages provided for within an insurance  contract
 subject to the provisions of this title.]
   §  5.  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-

 A. 5339                             3
 
 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.
   §  6. 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.
   §  7. 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:
   3.  (a)  [Providers  of  evaluations  and early intervention services,
 hereinafter 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 for evaluations
 conducted under the program and for services rendered to eligible  chil-
 dren, 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 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] (B) 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)] (C) A municipality, or its designee,  and  a  provider  shall  be
 subrogated,  to  the  extent of the expenditures by such municipality or
 for early intervention services furnished to persons eligible for  bene-
 fits 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

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 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.
   § 8. Subdivision 3 of  section  2543  of  the  public  health  law  is
 REPEALED.
   § 9. Section 3235-a of the insurance law is REPEALED.
   §  10.  Subparagraph  (F) of paragraph 25 of subsection (i) of section
 3216 of the insurance law is REPEALED.
   § 11. Subparagraph (F) of paragraph 17 of subsection  (1)  of  section
 3221 of the insurance law is REPEALED.
   §  12. Paragraph 6 of subsection (ee) of section 4303 of the insurance
 law is REPEALED.
   § 13. This act shall take effect January 1, 2022;  provided,  however,
 that  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. Effective imme-
 diately, the addition, amendment and/or repeal of any rule or regulation
 necessary for the implementation of this act on its effective  date  are
 authorized to be made and completed by the commissioner of health, on or
 before such effective date.