2023 New York Laws › PBH - Public Health › Article 25 - Maternal and Child Health › Title 2-A - Early Intervention Program for Infants and Toddlers With Disabilities and Their Families › 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.