N.Y. Pub. Health Law § 2559

§ 2559. Third party insurance and medical assistance program payments.\n1. Nothing in this title shall be construed to permit the department or\nany other state agency or municipality to reduce medical assistance or\nother assistance or services available to eligible children.\n 2. Notwithstanding any other provisions of law, costs incurred for\nearly intervention services that otherwise qualify as medical assistance\nthat are furnished to an eligible child who is also eligible for\nbenefits pursuant to title eleven of article five of the social services\nlaw are considered to be medical assistance for purposes of payments to\nproviders and state reimbursement to the extent that federal financial\nparticipation is available therefor.\n 3. (a) Providers of evaluations and early intervention services,\nhereinafter collectively referred to in this subdivision as "provider"\nor "providers", shall in the first instance and where applicable, seek\npayment from all third party payors including governmental agencies\nprior to claiming payment from a given municipality for evaluations\nconducted under the program and for services rendered to eligible\nchildren, provided that, the obligation to seek payment shall not apply\nto a payment from a third party payor who is not prohibited from\napplying such payment, and will apply such payment, to an annual or\nlifetime limit specified in the insured's policy.\n (i) Parents shall provide the municipality and service coordinator\ninformation on any insurance policy, plan or contract under which an\neligible child has coverage.\n (ii) Parents shall provide the municipality and the service\ncoordinator with a written referral from a primary care provider as\ndocumentation, for eligible children, of the medical necessity of early\nintervention services.\n (iii) providers shall utilize the department's fiscal agent and data\nsystem for claiming payment for evaluations and services rendered under\nthe early intervention program.\n (b) The commissioner, in consultation with the director of budget and\nthe superintendent of financial services, shall promulgate regulations\nproviding public reimbursement for deductibles and copayments which are\nimposed under an insurance policy or health benefit plan to the extent\nthat such deductibles and copayments are applicable to early\nintervention services.\n (c) Payments made for early intervention services under an insurance\npolicy or health benefit plan, including payments made by the medical\nassistance program or other governmental third party payor, which are\nprovided as part of an IFSP pursuant to section twenty-five hundred\nforty-five of this title shall not be applied by the insurer or plan\nadministrator against any maximum lifetime or annual limits specified in\nthe policy or health benefits plan, pursuant to section eleven of the\nchapter of the laws of nineteen hundred ninety-two which added this\ntitle.\n (d) A municipality, or its designee, and a provider shall be\nsubrogated, to the extent of the expenditures by such municipality or\nfor early intervention services furnished to persons eligible for\nbenefits under this title, to any rights such person may have or be\nentitled to from third party reimbursement. The provider shall submit\nnotice to the insurer or plan administrator of his or her exercise of\nsuch right of subrogation upon the provider's assignment as the early\nintervention service provider for the child. The right of subrogation\ndoes not attach to benefits paid or provided under any health insurance\npolicy or health benefits plan prior to receipt of written notice of the\nexercise of subrogation rights by the insurer or plan administrator\nproviding such benefits.\n 4. Notwithstanding any other provision of law, the commissioner,\npursuant to a memorandum of understanding with the commissioner of the\noffice of mental retardation and developmental disabilities, shall\ndevelop and submit a medicaid home and community based services waiver,\npursuant to section 1915c of the social security act, for the purpose of\ncreating a waiver program to provide and finance services for children\nwho qualify for the early intervention program. In further establishing\neligibility criteria under the waiver program, the commissioner, in\nconjunction with the commissioner of the office of mental retardation\nand developmental disabilities, shall establish health, developmental\nand psycho-social criteria which shall permit the broadest eligibility\nbased on criteria for the early intervention program and federal\nstandards for participation in a waiver program. The waiver application\nshall be submitted pursuant to section 1915c of the social security act\nno later than January first, two thousand four.\n 5. Notwithstanding any law to the contrary, there is hereby\nestablished an early intervention demonstration project to be conducted\nin Albany, Montgomery, Rensselaer, Saratoga and Schenectady Counties.\nSuch project shall be for the purposes of facilitating coverage\neligibility determinations and claims submissions for early intervention\nservices. The commissioner is hereby authorized and directed to\nfacilitate and, within the amounts appropriated, shall award grant funds\nfor the implementation and operation of such demonstration project which\nshall be conducted by an association representative of health\nmaintenance organizations licensed under article forty-four of this\nchapter and article forty-three of the insurance law in conjunction with\nthe commissioner and the counties specified in this subdivision.\n Such demonstration shall include the development of an integrated web\nportal enabling access to health plan data bases to facilitate coverage\neligibility, benefit determinations and claims submission and\nprocessing. Such access shall be subject to all federal and state laws\nfor the confidentiality of personal and medical record information. The\ndemonstration will develop technology solutions to facilitate coverage\ndeterminations and streamline and monitor claims processes and payment.\n The association conducting the demonstration, the commissioner and\nparticipating counties shall submit a report to the temporary president\nof the senate and the speaker of the assembly, not later than one year\nfollowing the commencement of the program's operation, describing the\nexperiences, feasibility and advisability of replication, and any\nadditional recommendations for continuation, modification or cessation\nof the program.\n