N.Y. Public Health Law § 2559: Medical assistance program payments

§ 2559. Medical assistance program payments. 1. Nothing in this title

shall be construed to permit the department or any other state agency or

municipality to reduce medical assistance or other assistance or

services available to eligible children.

2. Notwithstanding any other provisions of law, costs incurred for

early intervention services that otherwise qualify as medical assistance

that are furnished to an eligible child who is also eligible for

benefits pursuant to title eleven of article five of the social services

law are considered to be medical assistance for purposes of payments to

providers and state reimbursement to the extent that federal financial

participation is available therefor.

3. (a) Parents shall provide the municipality and the service

coordinator with a written referral from a primary care provider as

documentation, for eligible children, of the medical necessity of early

intervention services.

(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.

(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

benefits under this title, to any rights such person may have or be

entitled to from 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 assignment as

the early intervention service provider for the child. The right of

subrogation does not attach to benefits paid or provided prior to

receipt of written notice of the exercise of subrogation rights.

Notwithstanding any inconsistent 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.

4. Notwithstanding any other provision of law, the commissioner,

pursuant to a memorandum of understanding with the commissioner of the

office for people with developmental disabilities, shall develop and

submit a medicaid home and community based services waiver, pursuant to

section 1915c of the social security act, for the purpose of creating a

waiver program to provide and finance services for children who qualify

for the early intervention program. In further establishing eligibility

criteria under the waiver program, the commissioner, in conjunction with

the commissioner of the office for people with developmental

disabilities, shall establish health, developmental and psycho-social

criteria which shall permit the broadest eligibility based on criteria

for the early intervention program and federal standards for

participation in a waiver program. The waiver application shall be

submitted pursuant to section 1915c of the social security act no later

than January first, two thousand four.

5. Notwithstanding any law to the contrary, there is hereby

established an early intervention demonstration project to be conducted

in Albany, Montgomery, Rensselaer, Saratoga and Schenectady Counties.

Such project shall be for the purposes of facilitating coverage

eligibility determinations and claims submissions for early intervention

services. The commissioner is hereby authorized and directed to

facilitate and, within the amounts appropriated, shall award grant funds

for the implementation and operation of such demonstration project which

shall be conducted by an association representative of health

maintenance organizations licensed under article forty-four of this

chapter and article forty-three of the insurance law in conjunction with

the commissioner and the counties specified in this subdivision.

Such demonstration shall include the development of an integrated web

portal enabling access to health plan data bases to facilitate coverage

eligibility, benefit determinations and claims submission and

processing. Such access shall be subject to all federal and state laws

for the confidentiality of personal and medical record information. The

demonstration will develop technology solutions to facilitate coverage

determinations and streamline and monitor claims processes and payment.

The association conducting the demonstration, the commissioner and

participating counties shall submit a report to the temporary president

of the senate and the speaker of the assembly, not later than one year

following the commencement of the program's operation, describing the

experiences, feasibility and advisability of replication, and any

additional recommendations for continuation, modification or cessation

of the program.