2006 New York Code - 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 any plan of
  insurance or state government benefit 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.
    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 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. 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.
    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.
    4.  The commissioner shall collect data, by municipality, on the early
  intervention  program  authorized  under  this  title  for  purposes  of
  improving  the  efficiency,  cost  effectiveness,  and  quality  of such
  program. Such municipality data collection  shall  include  but  not  be
  limited to:
    (a) The number and ages of children enrolled in the early intervention
  program;
    (b)  The  total number of children, within a municipality, receiving a
  single service, the percentage of those children by  service  type,  and
  the average frequency of visits per week for such service type;
    (c)  The  total  number  of children, within a municipality, receiving
  multiple services, the percentage of those children by service type, the
  average frequency of visits per week  for  such  service  type  and  the
  average number of service types that each child receives;
    (d)  The  number of New York state approved agencies, institutions, or
  organizations providing early intervention services by service specialty
  or specialties and the number of New  York  state  approved  independent
  providers  of  early  intervention  services  by  service  specialty  or
  specialties;
    (e) The number and percentage of children receiving a  single  service
  by  type of New York state approved service provider, and the number and
  percentage of children receiving multiple services by type of  New  York
  state approved service provider;
    (f)  The  overall  number  of  New York state approved evaluators. The
  number of  approved  evaluators  who  also  provide  services  to  early
  intervention children they have evaluated;
    (g)  The  number of families receiving family supportive services such
  as family training, counseling, parent support groups, and respite;
    (h) The types of clinical practice guidelines,  evaluation  tools  and
  testing  instruments  used by municipalities to establish eligibility or
  need for early intervention services;
    (i) Both service,  cost  and  payment  oversight  mechanisms  used  by
  counties  to ensure quality and efficient delivery of early intervention
  services;
    (j) The number of children that have third party reimbursement;
    (k)  The  number  of  claims  submitted  to  third  party  payors   by
  municipality. The percentage of claims denied by third party payors. The
  reasons for the denials.
    The  commissioner  shall  collect  and  analyze  such data elements to
  determine  service  and  utilization  patterns  and   to   enhance   the
  department's  ongoing  provision  of  program oversight and guidance. In
  addition, the commissioner shall report for the period July  first,  two
  thousand  three  to  December  thirty-first, two thousand three, and for
  each calendar year thereafter, to the governor and the  legislature,  by
  March  first of each year, the information and analysis required by this
  subdivision.
    5. The department shall contract with an independent  organization  to
  act  as the fiscal agent for the department. A municipality may elect to
  utilize the services of such organization for early intervention program
  fiscal management and claiming as determined by the commissioner or  may
  select  an  independent  agent  to  act  as  the  fiscal  agent for such
  municipality or may act as its own fiscal agent.