2006 New York Code - Third Party Insurance And Medical Assistance Program Payments.

 
    § 2559. Third party insurance and 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)  Providers  of  early intervention services and transportation
  services shall in the first instance and where applicable, seek  payment
  from  all  third  party  payors including governmental agencies prior to
  claiming payment from a given  municipality  for  services  rendered  to
  eligible  children,  provided  that,  for the purpose of seeking payment
  from the medical assistance program or from other  third  party  payors,
  the municipality shall be deemed the provider of such early intervention
  services  to  the extent that the provider has promptly furnished to the
  municipality adequate and complete information necessary to support  the
  municipality  billing,  and provided further that the obligation to seek
  payment shall not apply to a payment from a third party payor who is not
  prohibited from applying such payment, and will apply such  payment,  to
  an annual or lifetime limit specified in the insured's policy.
    (b)  The commissioner, in consultation with the director of budget and
  the superintendent of insurance, shall promulgate regulations  providing
  public  reimbursement  for  deductibles and copayments which are imposed
  under an insurance policy or health benefit plan to the extent that such
  deductibles  and  copayments  are  applicable  to   early   intervention
  services.
    (c)  Payments  made for early intervention services under an insurance
  policy or health benefit plan which are provided  as  part  of  an  IFSP
  pursuant  to  section twenty-five hundred forty-five of this title shall
  not be applied by the insurer or plan administrator against any  maximum
  lifetime  or  annual  limits  specified in the policy or health benefits
  plan, pursuant to section eleven of the chapter of the laws of  nineteen
  hundred ninety-two which added this title.
    (d)  A  municipality,  or  its  designee,  shall be subrogated, to the
  extent of the expenditures by such municipality 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 third party
  reimbursement. The right of subrogation does not attach to benefits paid
  or provided under any health insurance policy or  health  benefits  plan
  prior to receipt of written notice of the exercise of subrogation rights
  by the insurer or plan administrator providing such benefits.
    4.  Notwithstanding  any  other  provision  of  law, the commissioner,
  pursuant to a memorandum of understanding with the commissioner  of  the
  office  of  mental  retardation  and  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  of  mental  retardation
  and  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 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,  with  input  from  the
  participating  counties,  shall submit a report to the commissioner, 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.