§ 2559 — Medical assistance program payments

§ 2559. Medical assistance program payments. 1. Nothing in this title\nshall be construed to permit the department or any other state agency or\nmunicipality to reduce medical assistance or other assistance or\nservices 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) 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 (b) 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 (c) 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 the medical assistance program. The provider shall\nsubmit notice to the insurer or plan administrator of his or her\nexercise of such right of subrogation upon the provider's assignment as\nthe early intervention service provider for the child. The right of\nsubrogation does not attach to benefits paid or provided prior to\nreceipt of written notice of the exercise of subrogation rights.\nNotwithstanding any inconsistent provision of this title, except as\nprovided for herein, no third party payor other than the medical\nassistance program shall be required to reimburse for early intervention\nservices provided under this title.\n 4. Notwithstanding any other provision of law, the commissioner,\npursuant to a memorandum of understanding with the commissioner of the\noffice for people with developmental disabilities, shall develop and\nsubmit a medicaid home and community based services waiver, pursuant to\nsection 1915c of the social security act, for the purpose of creating a\nwaiver program to provide and finance services for children who qualify\nfor the early intervention program. In further establishing eligibility\ncriteria under the waiver program, the commissioner, in conjunction with\nthe commissioner of the office for people with developmental\ndisabilities, shall establish health, developmental and psycho-social\ncriteria which shall permit the broadest eligibility based on criteria\nfor the early intervention program and federal standards for\nparticipation in a waiver program. The waiver application shall be\nsubmitted pursuant to section 1915c of the social security act no later\nthan 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