§ 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.

Terms Used In N.Y. Public Health Law 2559

  • Early intervention services: means developmental services that:

    (a) are provided under public supervision;

    (b) are selected in collaboration with the parents;

    (c) are designed to meet a child's developmental needs in any one or more of the following areas:

    (i) physical development, including vision and hearing,

    (ii) cognitive development,

    (iii) communication development,

    (iv) social or emotional development, or

    (v) adaptive development;

    (d) meet the coordinated standards and procedures;

    (e) are provided by qualified personnel;

    (f) are provided in conformity with an IFSP;

    (g) are, to the maximum extent appropriate, provided in natural environments, including the home and community settings where children without disabilities would participate;

    (h) include, as appropriate:

    (i) family training, counseling, home visits and parent support groups,

    (ii) special instruction,

    (iii) speech pathology and audiology,

    (iv) occupational therapy,

    (v) physical therapy,

    (vi) psychological services,

    (vii) case management services, hereafter referred to as service coordination services,

    (viii) medical services for diagnostic or evaluation purposes, subject to reasonable prior approval requirements for exceptionally expensive services, as prescribed by the commissioner,

    (ix) early identification, screening, and assessment services,

    (x) health services necessary to enable the infant or toddler to benefit from the other early intervention services,

    (xi) nursing services,

    (xii) nutrition services,

    (xiii) social work services,

    (xiv) vision services,

    (xv) assistive technology devices and assistive technology services,

    (xvi) transportation and related costs that are necessary to enable a child and the child's family to receive early intervention services, and

    (xvii) other appropriate services approved by the commissioner. See N.Y. Public Health Law 2541
  • Eligible child: means an infant or toddler from birth through age two who has a disability; provided, however, that any toddler with a disability who has been determined to be eligible for program services under § 4410 of the education law and:

    (i) who turns three years of age on or before the thirty-first day of August shall, if requested by the parent, be eligible to receive early intervention services contained in an IFSP until the first day of September of that calendar year; or

    (ii) who turns three years of age on or after the first day of September shall, if requested by the parent and if already receiving services pursuant to this title, be eligible to continue receiving such services until the second day of January of the following calendar year. See N.Y. Public Health Law 2541
  • Municipality: means a county outside the city of New York or the city of New York in the case of a county contained within the city of New York. See N.Y. Public Health Law 2541
  • Service coordinator: means a person who:

    (a) meets the qualifications established in federal law and regulation and demonstrates knowledge and understanding of:

    (i) infants and toddlers who may be eligible for services under this title;

    (ii) principles of family-centered services;

    (iii) part H of the federal individuals with disabilities education act and its corresponding regulations;

    (iv) the nature and scope of services available under this title; and

    (v) the requirements for authorizing and paying for such services and other pertinent information;

    (b) is responsible for:

    (i) assisting eligible children and their families in gaining access to services listed on the IFSP;

    (ii) coordinating early intervention services with other services such as medical and health services provided to the child;

    (iii) coordinating the performance of evaluations and assessments;

    (iv) participating in the development, monitoring and evaluation of the IFSP;

    (v) assisting the parent in identifying available service providers;

    (vi) coordinating service delivery;

    (vii) informing the family of advocacy services;

    (viii) where appropriate, facilitating the transition of the child to other appropriate services; and

    (ix) assisting in resolving any disputes which may arise between the family and service providers, as necessary and appropriate; and

    (c) meets such other standards as are specified pursuant to section twenty-five hundred fifty-one of this title. See N.Y. Public Health Law 2541
  • Year: shall mean the twelve-month period commencing July first unless otherwise specified. See N.Y. Public Health Law 2541

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 5 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 44 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.

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