N.Y. Social Services Law § 368-e: Reimbursement to counties for pre-school children with handicapping conditions

§ 368-e. Reimbursement to counties for pre-school children with

handicapping conditions. 1. The department of health shall review claims

for expenditures made by counties and the city of New York for medical

care, services and supplies which are furnished to preschool children

with handicapping conditions or such preschool children suspected of

having handicapping conditions, as such children are defined in the

education law. If approved by the department, payment for such medical

care, services and supplies which would otherwise qualify for

reimbursement under this title and which are furnished in accordance

with this title and the regulations of the department to such children,

shall be made in accordance with the department's approved medical

assistance fee schedules by payment to such county or city which

furnished the care, services or supplies either directly or by contract.

Notwithstanding any provisions of law, rule or regulation to the

contrary, any clinic or diagnostic and treatment center licensed under

article twenty-eight of the public health law, which as determined by

the state education department, in conjunction with the department of

health, has a less than arms length relationship with the provider

approved under section forty-four hundred ten of the education law

shall, subject to the approval of the department and based on standards

developed by the department, be authorized to directly submit such

claims for medical assistance, services or supplies so furnished for any

period beginning on or after July first, nineteen hundred ninety-seven.

The actual full cost of the individualized education program (IEP)

related services incurred by the clinic shall be reported on the New

York State Consolidated Fiscal Report in the education law section

forty-four hundred ten program cost center in which the student is

placed and the associated medical assistance revenue shall be reported

in the same manner.

2. Claims for payment under this section shall be made in such form

and manner, at such times, and for such periods as the department may

require.

3. The commissioner of health is authorized to contract with one or

more entities to conduct a study to determine actual direct and indirect

costs incurred by counties for medical care, services and supplies,

including related special education services and special transportation,

furnished to pre-school children with handicapping conditions.

4. Notwithstanding any inconsistent provision of sections one hundred

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

one hundred forty-two of the economic development law, or any other law,

the commissioner of health is authorized to enter into a contract or

contracts under subdivision three of this section without a competitive

bid or request for proposal process, provided, however, that:

(a) The department of health shall post on its website, for a period

of no less than thirty days:

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

the contract or contracts;

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

(iii) 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

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

selection, which may include submission by electronic means;

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

prospective contractors in timely fashion shall be reviewed by the

commissioner of health; and

(c) The commissioner of health shall select such contractor or

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

purposes of this section.

(d) Upon selection of a contractor or contractors, the department of

health shall provide written notification of such selection and a

summary of the criteria employed in such selection to the chair of the

senate finance committee and the chair of the assembly ways and means

committee.

5. The commissioner shall evaluate the results of the study conducted

pursuant to subdivision three of this section to determine, after

identification of actual direct and indirect costs incurred by counties

for medical care, services, and supplies furnished to pre-school

children with handicapping conditions, whether it is advisable to claim

federal reimbursement for expenditures under this section as certified

public expenditures. In the event such claims are submitted, if federal

reimbursement received for certified public expenditures on behalf of

medical assistance recipients whose assistance and care are the

responsibility of a social services district, results in a decrease in

the state share of annual expenditures pursuant to this section for such

recipients, then to the extent that the amount of any such decrease when

combined with any decrease in the state share of annual expenditures

described in subdivision six of section three hundred sixty-eight-d of

this title exceeds one hundred fifty million dollars for the period

April 1, 2011 through March 31, 2013, or exceeds one hundred million

dollars in state fiscal years 2013-14 and 2014-15, the excess amount

shall be transferred to such counties in amounts proportional to their

percentage contribution to the statewide savings; an amount equal to

thirteen and five hundredths percent of any decrease in the state share

of annual expenditures pursuant to this section for such recipients in

state fiscal year 2015-16 and any fiscal year thereafter shall be

transferred to such counties in amounts proportional to their percentage

contribution to the statewide savings. Any amount transferred pursuant

to this section shall not be considered a revenue received by such

social services district in determining the district's actual medical

assistance expenditures for purposes of paragraph (b) of section one of

part C of chapter fifty-eight of the laws of two thousand five.

The provisions of this section shall be of no force and effect unless

all necessary approvals under federal law and regulation have been

obtained to receive federal financial participation in the costs of

health care services provided pursuant to this section.