N.Y. Public Health Law § 2557: Financial responsibility and reimbursement

§ 2557. Financial responsibility and reimbursement. 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 eligible

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

regulations 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 the medical

assistance program under which an eligible child may have coverage.

2. The department shall reimburse the approved costs paid by a

municipality for the purposes of this title, other than those

reimbursable by the medical assistance program, 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

municipality, 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.

3. The department may perform audits, which may include site

visitation, to all or any of the following: municipalities; service

coordinators; evaluators or providers of early intervention services.

The department shall provide the municipalities with a copy of the

findings of such audits. Early intervention program state aid

reimbursement or portion thereof may be withheld if, on post-audit and

review, the commissioner finds that the early intervention services were

not provided or those provided were not in substantial conformance with

the rules and regulations established by the commissioner or that the

recipient of such services was not an eligible child as defined in

section twenty-five hundred forty-one of this title. In the event that

the commissioner determines that there may be a withholding of state

reimbursement to any municipality under this section, he shall inform

the state early intervention coordinating council and the relevant local

early intervention coordinating council and shall consider alternative

courses of action recommended within sixty days by either body prior to

withholding state reimbursement.

3-a. Each municipality may perform an audit, which may include site

visitation, of evaluators and providers of such services within its

municipality in accordance with standards established by the

commissioner. The municipality shall submit the results of any such

audit to the commissioner for review and, if warranted, adjustments in

state aid reimbursement pursuant to subdivision three of this section,

as well as for recovery by the municipality of its share of any

disallowances identified in such audit.

5. (a) The commissioner, in his or her discretion, is authorized to

contract with one or more entities to act as the fiscal agent for the

department and municipalities with respect to fiscal management and

payment of early intervention claims. Municipalities shall grant

sufficient authority to the fiscal agent to act on their behalf.

Municipalities, and individual and agency providers as defined by the

commissioner in regulation shall utilize such fiscal agent for payment

of early intervention claims as determined by the department and shall

provide such information and documentation as required by the department

and necessary for the fiscal agent to carry out its duties.

(b) Notwithstanding any inconsistent provision of section one hundred

twelve or one hundred sixty-three of the state finance law, sections one

hundred forty-two and one hundred forty-three of the economic

development law, or any other contrary provision of law, the

commissioner is authorized to enter into a contract or contracts under

paragraph (a) of this subdivision without a competitive bid or request

for proposal process, provided, however, that:

(i) The department shall post on its website, for a period of no less

than thirty days:

(1) A description of the proposed services to be provided pursuant to

the contract or contracts;

(2) The criteria for selection of a contractor or contractors;

(3) The period of time during which a prospective contractor may seek

selection, which shall be no less than thirty days after such

information is first posted on the website; and

(4) The manner by which a prospective contractor may seek such

selection, which may include submission by electronic means;

(ii) All reasonable and responsive submissions that are received from

prospective contractors in a timely fashion shall be reviewed by the

commissioner; and

(iii) The commissioner shall select such contractor or contractors

that, in his or her discretion, are best suited to serve the purposes of

this section.

(c) Paragraph (b) of this subdivision shall apply only to the initial

contract or contracts necessary to obtain the services of a fiscal agent

for early intervention program fiscal management and payment of early

intervention claims and shall not apply to subsequent contracts needed

to maintain such services, as determined by the commissioner in his or

her discretion.