BILL NUMBER: S4468A

SPONSOR: MANNION
 
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 reimburse-
ment of a service furnished by a local service provider while the
commissioner approves the service, provided that such approval is ulti-
mately granted. This section also provides that if a service is ulti-
              

mately not approved and reimbursement has already occurred, such
reimbursement shall be returned to the Office for People with Develop-
mental Disabilities within sixty days of notice of such denial. This
legislation is limited to a 1 year lookback period.

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, reha-
bilitation, training, and research for the benefit of individual s 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 avail-
able therefore by appropriation, grant, gift, devise, bequest, or allo-
cation 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 indi-
vidual 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. Further-
more, 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 ulti-
mately 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 legis-
lation will foster the relationship between all of these parties,
including individuals with developmental disabilities and their fami-
lies, local service providers, and OPWDD.  As such it is imperative that
this bill is enacted.

 
LEGISLATIVE HISTORY:

2019-20: S4013 reported and committed to finance

2017-18: A7868 referred to Ways & Means S1916 referred to Finance

2015-16: S.5544-A Reported and Committed to Finance.

 
FISCAL IMPLICATIONS:

Minimal.

 
EFFECTIVE DATE:
This act shall take effect immediately.